Adolescent preventive health care — formative SAQs

SAQ 1 — Confidential preventive visit (10 marks)

A 15-year-old attends with their mother for a “school medical.” The mother answers every question. Growth and BP are normal. [3] [2]

Questions

1. Explain why time alone and a confidentiality statement are required, and give a conditional confidentiality script. (4 marks) [2] [4]
2. List the classic HEADSS domains and one example question for each. (3 marks) [1]
3. State three preventive tasks beyond HEADSS that belong in this visit. (3 marks) [5] [6] [7]

Model answer

Time alone and confidentiality (4). Parent presence suppresses disclosure of sexual activity, substance use and mental-health concerns. Time alone is standard developmental care. Conditional script: private unless serious risk of harm to self/others, abuse, or legal duty to act; explain that you will try to plan any override with the young person. [2] [3] [4]

HEADSS (3). Home; Education; Activities; Drugs; Sexuality; Suicide/depression (safety throughout). One example question each as in standard teaching. Note HEEADSSS may add Eating/Safety expansions. [1]

Other preventive tasks (3). Growth/BMI/BP and indicated exam; immunisation review/catch-up; mood or substance screens when indicated; anticipatory guidance; transition planning in older teens; shared follow-up plan. [5] [6] [7]

SAQ 2 — Positive screens and inpatient opportunity (10 marks)

A. A clinic PHQ-based depression screen is positive in a 16-year-old who minimises symptoms. B. Separately, a 14-year-old is admitted with asthma and no psychosocial history is taken. [5] [8]

Questions

1. Outline same-visit actions after a positive depression screen. (4 marks) [5]
2. Explain why HEADSS still matters for the hospitalised adolescent. (3 marks) [8] [1]
3. When must confidentiality be overridden, and how do you communicate that? (3 marks) [4]

Model answer

Positive depression screen (4). Assess suicide ideation, plan, intent, means, prior attempts, protective factors and ability to stay safe. Decide urgent crisis/ED pathway versus early outpatient review with safety plan. Do not rely on delayed psychology alone if high risk. Involve supports according to risk and consent framework. [5]

Inpatient HEADSS (3). Hospitalised adolescents often have elevated psychosocial risk; missed HEADSS opportunities are documented. Opportunistic focused screening can change safety planning and disposition even if the admission diagnosis is medical. [8] [1]

Override (3). Serious risk of harm to self/others, abuse/assault, and other legal mandates. Tell the young person what must be shared and why; share the minimum necessary; involve parent/carer or authorities as required while preserving dignity. [4]