Psychosocial Assessment

The First Adolescent Visit

(Click to see larger image)

First, meet with the patient and the parents or guardians together to initiate rapport building:

• Obtain history of present illness, medical history, and family history.
• Inform patients and parents of local laws governing adolescent consent for care.
• Explain your need to meet separately with patients and their parents or guardians, and review your confidentiality policy with each patient and family. Be aware that parents or guardians may hold values that influence the amount of responsibility they are willing to give adolescents regarding their health care decision making. The degree of latitude may vary with the age of the adolescent. Parents also may have fears that their child could put himself or herself at risk of harm or illness. It is necessary to talk with parents and address any concerns they may have about your need to meet separately with their child.

Then, meet with the patient alone:

• Assure the patient that you are trustworthy, and encourage honesty in all dialogue.
• Administer the HEADSS interview, taking into account any adaptations that may be warranted on the basis of cultural, racial, or ethnic considerations.
• Conduct any necessary physical examinations.
• Review your findings and thoughts with the patient.

Next, meet with the parents or guardians alone:

• Remind them of the confidentiality agreement.
• Ask whether they have any concerns to share with you.
• Discuss any appropriate concerns of your own that may have arisen from the visit.

Finally, review results of the visit with the patient and family and, if you have received permission from both parties, discuss issues that were raised during the visit.

See larger image: Important Components of the First Adolescent Visit