Probing for scars: how to ask the essential questions

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Date: Jan. 2014
From: Contemporary Pediatrics(Vol. 31, Issue 1)
Publisher: Intellisphere, LLC
Document Type: Article
Length: 5,346 words
Lexile Measure: 1400L

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The HEEADSSS psychosocial interview is a practical, time-tested strategy that pediatricians can use to evaluate how their teenaged patients are coping with the pressures of daily living, especially now in the context of electronic and social media.

For most teenagers, a psychosocial history is at least as important as the physical exam. This essential psychosocial history can be obtained using the HEEADSSS method of interviewing adolescents. The HEEADSSS interview focuses on assessment of the Home environment, Education and employment, Eating, peer-related Activities, Drugs, Sexuality, Suicide/depression, and Safety from injury and violence (Table 1). (1,2)

Because adolescence is a time of growth and development when threats to health can arise, these threats are often related to physical and social exploration. For example, sexual exploration may lead to sexually transmitted infections or unintended pregnancies. Experimentation with drugs or alcohol is another cause of morbidity and mortality that is implicated in deadly motor vehicle crashes in the age group. In fact, unintentional injuries, homicide, and suicide are among the leading causes of adolescent deaths in the United States, and are the top 3 causes for those aged 15 years and older. (3)

Moreover, consequences of adolescents' stressors may include obesity, eating disorders, depression, or other mental health problems. These issues are not easily identified or addressed using a strictly physiologic orientation.

Without an adequate psychosocial history, one is unlikely to spot problems early enough to significantly reduce adolescent morbidity and mortality. The HEEADSSS interview is a practical, time-tested strategy that physicians can use to obtain a "psychosocial review of systems" for adolescent patients.

Since the second version of HEEADSSS was created in 2004, nearly all teenagers have obtained access to the Internet and three-quarters of them use cell phones and send text messages. (4,7) This utilization of media profoundly affects the lives of adolescents; media may now contribute to 10% to 20% of any specific health problem. (7) Thus, questions on new media use are critically important and are included in this HEEADSSS 3.0 update. In addition, this update emphasizes a strengths-based approach to the adolescent interview to foster patient-physician rapport and successful interventions.

How to use the psychosocial screen

You should begin spending time alone with your patients at whatever age they first exhibit the psychosocial changes associated with puberty. Generally, it is preferable to conduct the psychosocial interview when the adolescent is relatively well. (8) Nonetheless, situations of crisis or illness may sometimes facilitate effective history taking because vulnerability may foster trusting relationships. At every visit, the adolescent should be assessed for new stressors and overall well-being.

Working with parents

If the parents are present, first introduce yourself to the adolescent to make clear that the teenager is the patient. Then try having the adolescent introduce the other people in the room. Parents, family members, or other involved adults should not be present during the HEEADSSS interview because a parent's presence is likely to limit how much sensitive information the patient will provide. Allowing a parent to sit in...

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Gale Document Number: GALE|A456573642