Adolescent risk assessment and harm minimisation — formative SAQs

SAQ 1 — Cross-domain risk assessment (10 marks)

A 15-year-old presents with their parent for a sports medical. The parent answers every question. You secure time alone. The young person discloses occasional vaping, low mood for two weeks, and inconsistent condom use. [1] [3]

Questions

1. Define harm minimisation and contrast it with an abstinence-only stance. (3 marks) [4]
2. Outline how you would complete the risk assessment across all domains, naming the validated tools you would add where a lead appears. (4 marks) [1] [2] [5]
3. Describe the brief-intervention method you would use and why it fits adolescent development. (3 marks) [7] [8]

Model answer

Harm minimisation vs abstinence (3). Harm minimisation is a pragmatic public-health stance that reduces the adverse consequences of a risk behaviour even when the behaviour continues; abstinence remains one possible goal but not the only acceptable outcome. Abstinence-only messaging demands the behaviour stop now and treats relapse as failure, which disengages the highest-risk youth. Harm reduction keeps young people alive and in contact enough for bigger change. [4]

Risk assessment (4). Complete HEADSS/HEEADSSS across all domains: Home, Education, Eating, Activities, Drugs, Sexuality, Suicide/mood/Safety, strengths. Add validated tools where a lead appears: CRAFFT or a frequency-based screen for the vaping/substance lead; a mood/suicide instrument (ASQ or Columbia) for the low-mood lead, then a full suicide risk assessment if positive; sexual-health history with STI testing to disclosed sites and a coercion question asked separately. Move from universal inquiry to selective screening to indicated assessment as the history drives it. [1] [2] [5]

Brief intervention (3). Use motivational interviewing — open questions, affirmation, reflective listening, summaries — to evoke the young person's own reasons for change rather than lecture. This fits the dual-systems model: the reward system outruns prefrontal control through mid-adolescence, so willpower-only demands fail and reducing consequences works with the biology. [7] [8]

SAQ 2 — Positive screen, safety, and the harm bundle (10 marks)

A. A 16-year-old's suicide screen is positive; they describe a plan but say they will not act and beg you not to tell anyone. B. Separately, a 17-year-old discloses intermittent opioid use, believing the pills were "just relaxers." [5] [6]

Questions

1. Outline your same-visit actions after the positive suicide screen, including your confidentiality response. (5 marks) [5]
2. Describe the harm-reduction bundle you would offer the opioid-using adolescent. (5 marks) [4] [6]

Model answer

Positive suicide screen (5). Move from screen to structured same-visit risk assessment: ideation, plan, intent, prior attempts, access to means, protective factors, ability to keep safe. A plan with intent crosses into the override tier: confidentiality is limited by serious risk of harm, so explain what must be shared and why, remove access to means, do not leave the young person alone, and activate the crisis or mental-health pathway. Do not rely on a promise of secrecy or on delayed psychology alone. [5]

Opioid harm-reduction bundle (5). In the fentanyl era a young person may be exposed to a potent opioid without intending opioid use. Offer take-home naloxone plus overdose education to the young person and, with consent, to family or peers; give safer-use messaging (avoid mixing, start low, never use alone); assess for opioid-use disorder and link to opioid-substitution treatment; offer needle-syringe access and safe-disposal advice if injecting; and test for blood-borne viruses. Bundle sexual-health and mental-health harm reduction into the same plan. The stance is pragmatic and non-judgemental: lower the consequences today while keeping the door open for treatment. [4] [6]