ADOLESCENT HEALTH CHECK-UP
Assessment of an adolescent in terms of medical issues must follow the same process as for others, though some issues are important and needs to be considered:
• Privacy and confidentiality: Most adolescents prefer to discuss their health issues or concerns on one-to- one basis and may be hesitant to open-up even in presence of parents or friends.
Due regard for privacy is necessary during health assessment of an adolescent to permit him to discuss his/her concerns in a frank and friendly manner, without any disturbance or inhibition.Confidentiality is an assurance between adolescent and health-provider not to share the information exchanged between them during the assessment process, unless contravening the law or exposing him/ her to harm, e.g. suicide, abuse, etc.
• Communication and rapport building: Health-care provider must be empathetic and non-judgement towards the adolescent to ensure good communication. Use of simple ice-breaker questions before sensitive questions, showing interest in their concerns and permitting them to express freely without arguments will allow building of a rapport between HCW and adolescent.
• History-taking: History must be first obtained by the adolescent himself/herself before inving the parent to collaborate, if required. It is also advisable to go beyond the presenting complaints and enquire about other issues as well as family/school environment.
HEEADSSS is an acronym of a very useful tool to assess psychosocial history in almost all domains in adolescents. It includes eight components representing assessment of Home environment, Education/ employment status, performance and expectations, Eating/Exercise behavior including recent changes, Activities, hobbies and peer-relationships, Drug abuse/experimentation, Sexual activity/behavior, Suicide and mood/mental health status and Safety/ spirituality behavior including risk-taking.
• Consent is necessary from all adolescents 18 years of age for any examination/procedure, irrespective of the parental consent or refusal to consent and must be recorded in writing after due explanation.
In adolescents 12-18 years of age, both, an assent from them and a consent from parent is required. Parental consent is enough for children lt;12 years, though they must be explained the need and process of examination/procedure irrespective of the age.
• Physical examination must include assessment of physical growth by anthropometry vis a vis reference norms, sexual maturity using Tanner's SMR staging and detailed general and systemic examination. However, adolescents are often quite sensitive and vulnerable and following precautions are must during physical examination:
± Record the consent before examination, as discussed earlier.
± Ensure that a chaperone (Nurse/relative) of same sex as adolescent is present, if gender of the doctor differs from the patient.
± Ensure complete privacy in the examination room by closing the door or using heavy curtains
± Explain the adolescent steps and scope of examination, including the need for it, specially when assessing SMR.
± Watch for any discomfort or change in the behavior of adolescent and abort the examination if required.
• Disclosure: Explain the assessment findings at the end as well as interpretation and the need for further assessment, referral, follow-up or investigations.
• Information, education and counseling: All opportunities to interact with adolescents should be used to provide them necessary information about nutrition, sexual changes, life-style and mental health issues, other than addressing their specific health concerns.
Anticipatory guidance is defined as proactive counseling about expected physical, motional, psychological, and developmental changes in adolescents till next health visit to prepares them and their families for what to expect next in their child's development.
• Referral, if necessary for speciality services or other service delivery points, e.g. integrated counseling testing centre, de-addiction centres, social workers, mental health professionals, etc., after explaining the need for such referral.
Under the Protection of Child Rights Act, 2005 and Protection of Child from Sexual Offenses Act (POCSO) 2012, it is mandatory to inform regulatory authorities, if a heath care worker comes across any suspicion act of physical or sexual abuse during the assessment process in a child or adolescent lt; 18 years of age.
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