Adolescent consultation, HEEADSSS and confidentiality — formative SAQs

SAQ 1 — Setting up the consultation (10 marks)

A 15-year-old attends with a parent for a preventive visit. The parent answers every question and says "we have no secrets." [3] [7]

Questions

1. Explain why time alone and a stated confidentiality line are required, and give a conditional confidentiality script with its limits. (4 marks) [2] [4]
2. Describe how you would negotiate time alone with this parent. (3 marks) [3] [7]
3. List the eight HEEADSSS domains in order with one open question each. (3 marks) [1]

Model answer

Time alone and confidentiality (4). Parent presence suppresses disclosure of sexual activity, substance use and mental-health concerns, so time alone is a standard quality step, not an option. Conditional script: what we discuss is private unless there is serious risk of harm to self or others, abuse or assault, or a legal duty to act — and I would try to plan any override with you first. [2] [3] [4]

Negotiating time alone (3). Stay warm and firm. Frame private time as standard developmental care about the young person's growing independence, not about hiding things from the family. Give the parent a defined task (a questionnaire, the waiting area) and a clear time. Parents usually support time alone once it is explained well. [3] [7]

HEEADSSS (3). Home (who do you live with?); Education/Employment (how is school?); Eating (how do you feel about your body?); Activities (what do you do for fun?); Drugs (any vaping, alcohol or other substances?); Sexuality (are you attracted to anyone?); Suicide/mood (how is your mood?); Safety (do you feel safe at home and school?). One mark per three domains, all eight for full marks. [1]

SAQ 2 — Positive screens and a red-flag interrupt (10 marks)

A. A PHQ-based depression screen is positive in a 16-year-old who minimises symptoms. B. In a separate encounter, a 14-year-old discloses active suicidal intent with a plan for tonight and begs you not to tell anyone. [5] [4]

Questions

1. Outline the same-visit actions after a positive depression screen. (4 marks) [5]
2. Describe your immediate management of the active suicidal-intent disclosure, including the confidentiality decision. (4 marks) [4] [5]
3. Give two modern confidentiality breach vectors and one operational safeguard for each. (2 marks) [4]

Model answer

Positive depression screen (4). Do not file and forget. Same-visit suicide-risk assessment: ideation, plan, intent, access to means, prior attempts, protective factors, ability to stay safe tonight. Decide crisis/emergency pathway (high risk) versus early outpatient review with a written safety plan (lower risk). Do not rely on a delayed psychology referral for a high-risk young person. [5]

Active suicidal intent (4). Override confidentiality as required to keep the young person safe — active intent is a recognised override. Tell them what must be shared and why. Secure immediate safety; do not leave them alone; use the local crisis or emergency pathway. Share the minimum necessary with those who can keep them safe, and preserve dignity and future trust. [4] [5]

Breach vectors (2). Patient portal or open-notes transparency exposing a sensitive note (safeguard: sensitive-note workflows, confidential contact details); itemised billing or pharmacy text exposing content (safeguard: billing codes and dispensing workflows that do not betray content). [4]