Adolescent Patient Interviewing

=Objectives=

Definitions

 * Adolescence generally refers to the psycho-social growth and development, which generally start shortly after the onset of puberty and extend well beyond the legal age of 21. .  Adolescence is a process of formulating a distinct individual identity and developing the ability to respond to internal and external conflicts.  Freud considered this a conflict between Id and Ego; Piaget focused on attainment of formal thought.
 * Puberty is the physical transition from childhood to adulthood. Development of secondary sex characteristics, endocrinological changes, etc.

Describe the major characteristics and growth tasks of each phase of adolescence.
Adolescence can be divided into a progression through 3 phases (which do not necessarily correspond to chronological age).
 * Early Adolescence (~10 - 13 years
 * young teen begins to separate psychologically from the parents in an effort to formulate an individual identity. Must adjust to new body image (puberty) and begin to show sexual curiosity.
 * Associated with preoccupation with body changes, a unisex peer group, concrete thinking (Piaget), vague and unrealistic career plans (ie NBA basketball player), more and polictical code reflects parents


 * Middle Adolescence (~14 - 16 years)
 * Teens exhibit ambivalence about the separation process as they expose themselves to unfamiliar situations. May be expressed as hostility or bravado in some youths.  Middle adolescence is characterized by experimenting with different body images, styles, etc.
 * Begin to have heterosexual relationships, formal Thought (Piaget) present but variably applied, shift away from family morals


 * Late Adolescence (~17 years and older)
 * Young people are comfortable away from home. Teens may feel comfortable about returning to their parents to seek advice without feeling threatened or ashamed.
 * Confident with body & personal style, fewer but closer friends, sexual relationships more intimate, realistic career goals, develop personalized moral beliefs.

Describe the unique issues surrounding confidentiality, transference and counter transference when caring for an adolescent.

 * Confidentiality is an essential part of the therapeutic relationship. Information must not be divulged to parents without the patient's knowledge and consent. The limitations of confidentiality are:
 * if the young person plans to hurt themselves or others
 * in Oregon if they are seeking mental health or substance abuse help (except in abuse cases)
 * insurance billing sent to parents include procedural and diagnostic codes. accommodation may be necessary to preserve confidentiality
 * parents have the right to request records of their children


 * transference
 * refers to a patient projecting of feelings about another person upon the physician (e.g.: patient is angry with dad and transfers this anger to his physician).


 * countertransference
 * refers to the physician projecting feelings about another person onto the patient (e.g.: patient reminds the physician of his kid and acts too much like a dad).


 * Transference and countertransference may be either constructive or destructive. In the worst case, they make it difficult to counsel a patient objectively and can lead to a poor therapeutic relationship.

Describe and/or demonstrate effective techniques when interviewing the adolescent patient.

 * 1) Clearly describe confidentiality policies and limitations every time.
 * 2) Talk to the patient both with their parents present and alone with only the teen.
 * 3) Respect adolescent patient's autonomy
 * 4) Maintain a nonjudgmental attitude.
 * 5) Ask open ended questions.
 * 6) Make note of body language.
 * 7) Become comfortable with a patient’s sadness and tears.
 * 8) Silence may be a powerful tool.
 * 9) Use developmentally appropriate language when communicating your impression and plan.

Ask the HEADSS questions:
 * Home life - DV, relationships with family
 * Education -how school is going, favorite/hated subjects, grades
 * Activities - sports, music, friends
 * Drugs
 * Sex - start with crushes and keep going till you know what they're doing. see PCM1: Taking a Sexual History
 * Suicide

Describe relevant Oregon laws to adolescent health care and age cut offs

 * Any age, consent to care for a venereal disease.
 * 14 years obtain mental health or additional treatment (except for methadone) w/o parent's consent.
 * Parents must be contacted after treatment for mental health/substances has started unless there's sexual/parental abuse
 * 15 years or older may consent to general medical care, surgery, or dental care. Includes abortion. However, minors are not financially responsible.
 * Under 18, a physician CAN break confidentiality and advise parents WITHOUT a minor's consent.
 * Married adolescents "arrive at majority", meaning they are treated like 18 year olds.

Source: Oregon Revised Statues

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