Psychosocial Assessment

Transcript: Jason's First Visit

As video opens, a young man approaches and enters a clinic. The following text shows on screen:

• Patient: Jason
• 16-year-old African American male
• Tested HIV-positive last week at a mobile outreach site
• Reason for visit: Initial visit with an HIV care provider

Dr. Johnson: Come in. Hi, Jason. It's nice to see you again. I'm really glad you came back today.

Jason: I got to be honest, Doc. I almost didn't come.

Dr. Johnson: That's completely understandable. You're dealing with a very stressful situation. Great. Sit down. How are you holding up this past week?

Jason: I don't know.

Dr. Johnson: Are you sad?

Jason: Yes. Sometimes I'm sad. Sometimes I'm mad. A lot's been going through my mind since last week.

Dr. Johnson: It's completely understandable.

Jason: I'm feeling better, I guess. My mind isn't racing as much as it was last week. But I still feel like I'm under a lot of pressure since I found out.

Dr. Johnson: That's OK. Listen, Jason, I promise you that we're going to do everything we can to help you deal with what you're going through. We have a great team here and we're going to help you keep your mind and your body strong. OK?

Jason: OK.

Dr. Johnson: Good. Now let me tell you a little bit about how I like to work with young people like you, and your family. My office has a confidentiality policy, which I like to discuss with teens and the parents together at the first meeting. I let the family know that it's important during the visit that I spend some time alone with you and some time alone with them, but that some of the topics that we discussed they may not be shared. Most parents are OK with that.

Jason: Well, it's just my mom. My dad died a long time ago.

Dr. Johnson: I'm sorry to hear that. Is that something you'd like to talk about?

Jason: No. I'm OK. Thanks.

Dr. Johnson: OK. Now, there are exceptions when I may have to tell your mother what you tell me. For example, if you tell me that you're thinking about killing yourself or someone else, if you tell me that you've been hurt sexually or physically -- I'm not going to be able to keep that confidential. I'm going to have to do something to protect you. But now let's say that you're thinking about having sex, or that you had sex last week and your mom doesn't know about it -- well, I'm not going to go in the hallway and say, hey, mom, guess what, Jason had sex last week. If something should come up during one of our meetings that I think should be shared with your mom, I promise you, I will talk to you and get your OK before I do it. What do you think of that?

Jason: It sounds cool. I don't want anybody knowing my personal business.

Dr. Johnson: Right. OK. Let me start by getting some informantion about any past health problems that you may have had, and then I'm going to ask you some questions that may help me get to know you a bit better. Now, Jason, some of these questions are going to be personal, but remember, the more information I have, the better the chances are of me helping you and deciding what extra tests, if any, that we may need to do.

Jason: OK.

Dr. Johnson: Were you ever sick as a child?

[Video pauses]

Text on screen:

Taking a family medical history is especially important with adolescents, who are not only genetically affected but also environmentally affected by their families.

New screen:

After taking the history with the parents present, ask them to leave the room, and conduct the HEADSS interview alone with the patient to develop a more complete psychosocial assessment.

[Video resumes]

Dr. Johnson: Now I'm going to ask you some personal questions. I'm going to ask you about your home life. School. Your activities. Hobbies. Your eating patterns. Your feelings. And I'm going to ask you about sex and drug use. Remember, Jason, if you're uncomfortable answering any of these questions, just tell me and we can talk about it.

Jason: All right. It's just -- I've never spoken about sex and stuff to grownups.

Dr. Johnson: Listen, Jason, I wouldn't feel comfortable talking to a stranger about my sex life either, but hopefully I won't be a stranger for long. You and I are going to be working very closely together to keep you healthy. And I promise you, anything you say in this room stays between us. OK?

Jason: That's cool.

Dr. Johnson: Let's talk about your home. I know that you moved here recently. Who did you live with in Baltimore?

Jason: I lived with my mom and my two younger sisters. Like I said before my dad died when I was 6, in a car accident.

Dr. Johnson: Do you get along with your family?

Jason: My sisters are cool. They get on my nerves a lot, though. My mom and I, we don't get along so well. She's so hard on me, and she has all these stupid rules like, I have to be home by 8:00, and she doesn't want me to hang out with my friends. It's like jail.

Dr. Johnson: Are there any reasons for her to be so strict?

Jason: Well, I was hanging out with this gang, but I'm not in a gang. Anyway, my friends were hanging out one day at school and one of my friends stole a bike, and we were taking turns riding it. The cops came and they arrested all of us. But I didn't have anything to do with it, so I don't know why she got so pissed off.

Dr. Johnson: Is that the only time something like that has happened?

Jason: Well, there -- there's a few other things, like being late for school. Ditching school. And my grades got kind of low for a couple of quarters, but I'm doing better.

Dr. Johnson: Good. Let's talk about school. What grade are you in and what kind of grades are you getting?

Jason: I just finished my sophomore year with mostly C's. But that's better than D's and F's I got the first two quarters. I never failed a grade. My mom should be happy about that. I don't know why she doesn't. She says you should get A's and B's.

Dr. Johnson: Well, I know parents can sometimes seem like a pain. It's usually because they just want what's best for their children.

Jason: Yes. She says that all the time.

Dr. Johnson: So what kind of activities do you like?

Jason: Besides football, I like baseball; I like to go to the movies. OK. Well, this is kind of gay, but I like writing poetry.

Dr. Johnson: Poetry doesn't make you gay, Jason. I think that's cool. Have you ever seen Def Poetry Jam on HBO?

Jason: I love that show.

Dr. Johnson: Me, too. Have you ever shared your poems with anyone?

Jason: No. Not really. I read a couple to my mom before and she thought they were cool. My friends, though. Never. They'd probably just laugh at me.

Dr. Johnson: I don't know about that. I think you might be surprised. Now I'm going to ask you some very personal questions. If you're not comfortable answering them, just let me know. OK?

Jason: OK.

Dr. Johnson: Many young people your age have thought about or actually tried drinking, smoking, drug use. Let's just take these one at a time. Do you drink? Remember, Jason, I'm not going to tell anyone else what you tell me.

Jason: I -- Well, I've had a couple of beers.

Dr. Johnson: What's the most you've ever drank at one time?

Jason: One time I had three beers, but I usually just have one or two. I don't drink a lot. Honest, doc.

Dr. Johnson: OK. What about drugs?

Jason: Well, I've smoked weed, before, a couple of times, but I've never done any other drugs.

Dr. Johnson: When was the first time you smoked marijuana?

Jason: A few months ago.

Dr. Johnson: And how often do you smoke marijuana?

Jason: Every now and then.

Dr. Johnson: What about sex?

Jason: Yeah. I've had sex.

Dr. Johnson: How old were you when you had your first time?

Jason: I guess my first time was like 14.

Dr. Johnson: Do you have sex with females, males or both?

Jason: Doc, I ain't gay. I only get with women.

Dr. Johnson: That's OK. It would be fine if you were. I just want my patients to be comfortable. About how many women have you had sex with?

Jason: This is embarrassing, Doc.

Dr. Johnson: Jason, you can be honest with me. Remember, I'm not going to tell anyone anything that you don't want me to. Should I move on to another question, or do you think you can get over being embarrassed?

Jason: Well, I've had sex with a lot of women. Maybe like 20, 25.

Dr. Johnson: Have you ever had sex with women for anything?

Jason: Anything like what?

Dr. Johnson: Money, alcohol, drugs.

Jason: Are you kidding?

Dr. Johnson: I just have to ask that. Let me ask you this. Have you ever had oral sex or anal sex? Do you know what I mean by oral sex and anal sex?

Jason: You mean, have I ever gone down on a girl, or done them in the butt?

Dr. Johnson: Yes. Have you also had a girl give you a blowjob?

Jason: First of all, let's get one thing straight. I've never pimped myself out for money or anything like that. As for the other question, I've never ever gone down on a girl, but I've had girls suck me.

Dr. Johnson: Let me ask you this. When you have vaginal sex or oral sex, how often do you use a condom, always, sometimes, most of the time, or never?

Jason: Well, sometimes for real sex. Vaginal sex, but never for oral sex.

Dr. Johnson: All sex is real sex, wouldn't you agree?

Jason: I guess so.

Dr. Johnson: Do you have a sex partner now?

Jason: Not really. I haven't had sex since I moved from Baltimore last month, and believe me it's the last thing on my mind, now.

Dr. Johnson: Well, I think it's a good idea to wait a while before you have sex again, so you can sort things out. I want to talk to you more about that later. But there are a few more questions I need to ask first. Have you ever been really depressed or felt like hurting yourself?

Jason: You mean, since I got HIV?

Dr. Johnson: Yes, but even before? Have you ever had those feelings?

Jason: Well, before this happened, I never really thought about stuff too much. Now I just want to get myself together, so I can do what I got to do. Sometimes I get sad. Like what's going to happen to me with the HIV. I have a lot of trouble sleeping.

Dr. Johnson: I have an idea. Do you remember those folks you met last week at the van?

Jason: Yes.

Dr. Johnson: They work at the community health center in your neighborhood. They have a lot of great counselors that you can talk to about your feelings. They also have young people your age with HIV who get together once a week to talk about what they're going through. It's called a support group.

Jason: I have my family and some friends to talk to. I don't think I'm ready to talk about what's going on with me with a bunch of strangers.

Dr. Johnson: I hear you, Jason. I know that the idea of talking about HIV with strangers can seem scary, but I know a lot of young people just like you who've gotten a lot of strength from groups like this. I seriously want you to consider talking to a counselor at least once. I'll even call the community health center and see if Pat, the woman you met on the van last week, if she can meet you sometimes, what do you say to that?

Jason: That's cool. So what else do we got to do?

Dr. Johnson: We're going to spend a little more time talking about HIV so that you'll understand exactly what it is and how it can affect your body. Then I'll need to examine you and we'll do some more tests to tell me more about your HIV infection.

[End of Video]

[Text on screen]

Building trust is the key to conducting a successful psychosocial assessment:

• Treat the patient with the respect deserving of a young adult.
• Reinforce the importance of patients taking on the responsibility of looking after their own health.
• Emphasize your commitment to maintaining the patient's confidentiality.
• Gather the family history with parents present and then conduct the HEADSS interview alone with the patient.
• Do not make assumptions about a patient's sexual orientation.
• Discuss substance and sexual risk behaviors objectively so that patients never feel judged.
• Congratulate patients for any positive health behaviors you observe.

[End]