RANK CAUSE RATE (PER 100,000) 1 Unintentional injuries 30.3 2 Assault (homicide) 10.4 3 Suicide 6.9 4 Malignant neoplasms (cancer) 3.2 5 Diseases of the heart 1.6
From Centers for Disease Control and Prevention, National Center for Health Statistics: National Vital Statistics 2007.
alone (Table 67-5). Some issues cannot be kept confidential, such as suicidal intent and disclosure of sexual or physical abuse. If there is an ambiguous situation, it is wise to obtain legal, ethical, or social work consultation. When caring for a young adolescent, the health care provider should encourage open discussions with a parent, guardian, or other adult.
The law confers certain rights on adolescents, depending on their health condition and personal characteristics, allowing them to receive health services without parental permission (Table 67-6). Usually adolescents can seek health care without parental consent for reproductive, mental, and emergency health services. Emancipated adolescents and mature minors may be treated without parental consent; such status should be documented in the record. The key characteristics of mature minors are their competence and capacity to understand, not their chronologic age. There must be a reasonable judgment that the health intervention is in the best interests of the minor.
Auditory-visual defects 2%–3% Traumatic paralysis 2:1000 Scoliosis 3% males, 5% females Migraine 6%–27% (↑ with increasing age)
Diabetes mellitus 1.8:1000 Obesity 25%–30% Anorexia nervosa 0.5%–1% Bulimia 1% (young adolescence),
Figure 67-1 The Structured Communication Adolescent Guide (SCAG). The SCAG is an interviewing tool developed for learners to use with real or standardized adolescent patients. It incorporates the four major interview components: confidentiality, separation of the adolescent from the adult, psychosocial data gathering (using the HEADDSS mnemonic), and a nonjudgmental approach. The SCAG is at a grade 5 reading level and has demonstrated reliability and validity. A printable version is available through MedEdPORTAL.
Figure 67-1, cont’d “Get the story”
Setting Topics Confidentiality Separation HEADDSS See Table 67-5 Relationships Functioning Attitudes Behaviors Be nonjudgmental Avoid lecturing Never give up even if you feel uncomfortable Plan and contract Focus on your adolescent patient’s issues (acne, sore throats, belly pain, mom) and one of your concerns (safe sex, driving safety, depression) Choices – congratulate your adolescent on good choices Behaviors – emphasize the positive; focus on patient accomplishments
Contract – with adolescent around 1 or 2 risk-taking issues
Interview with empathy, interest, and understanding
Figure 67-2 STEP guide for adolescent interviewing.
Prepare the preadolescent and parent for confidentiality and being interviewed alone.
Discuss confidentiality at the start of the interview. Conversations with parents/guardians/adolescent are confidential (with exceptions*).
Reaffirm confidentiality when alone with your adolescent patient.
*Exceptions to confidentiality include major or impending harm to any person (i.e., abuse, suicide, homicide).
*The acronym HEADDSS can represent other terms, that is, A = Activities, D = Depression. Also see Figure 67-1.
Age of majority (≥18 years of age in most states)
Exceptions in which health care services can be provided to a minor*: Emergency care (e.g., life-threatening condition or condition in which a delay in treatment would increase significantly the likelihood of morbidity) Diagnosis and treatment of sexuality-related health care
Diagnosis and treatment of drug-related health care Emancipated minors (physically and financially independent of family; Armed Forces; married; childbirth)