Youth violence, risky behaviour and injury prevention — formative SAQs

SAQ 1 — Public-health approach and private screening (10 marks)

A 15-year-old is brought by a parent for a sports medical. The parent answers every question. You secure time alone. The young person then discloses school refusal due to bullying, occasional vaping, and that there is a loaded, unlocked firearm in the home "for protection." [1] [9]

Questions

1. Outline the four steps of the WHO public-health approach to violence prevention, and state where the clinician consultation sits within it. (3 marks) [1]
2. Describe how you would complete a private, developmentally framed violence and safety screen, naming the specific domains you must cover. (4 marks) [9] [3]
3. Explain your immediate management of the firearm disclosure and your confidentiality reasoning. (3 marks) [6] [7]

Model answer

WHO public-health model (3). The four steps are: define the problem, identify its causes and risk factors, design and evaluate interventions, then scale up what works. The clinician's consultation sits inside the fourth step — applying evidence-based prevention (GDL, safe storage, lethal-means counselling, SEL/PYD) to the individual young person in front of them, treating violence and injury as predictable and preventable rather than random. [1] [3]

Private violence and safety screen (4). Open with conditional confidentiality and its limits, then weave violence and safety into a HEeADSSS-shaped interview. Specifically cover: fighting and weapon-carrying; bullying as both target and perpetrator, including cyberbullying (online harassment, image-based abuse, exclusion); teen dating violence (control, coercion, fear, forced sexual contact); road risk (seatbelt, helmet, riding with an impaired driver, graduated-licensing conditions); water and sport safety; self-harm and suicide (ideation, plan, intent, prior attempts); and always access to lethal means — firearms in the home and homes they visit, stored how, and large medication quantities. Add validated screens where a lead appears: ASQ or Columbia for suicide, CRAFFT for substance. [9] [11] [13]

Firearm disclosure and confidentiality (3). Counsel safe storage — locked, unloaded, ammunition stored separately — and explain that reducing access lowers both firearm injury and suicide risk. Because the young person has disclosed school refusal and low mood (a possible suicide-risk lead), assess suicide risk fully before discharge; if risk is present, arrange temporary removal of the firearm from the home until the crisis resolves. Confidentiality is conditional: it holds unless there is serious risk of harm, in which case the clinician shares the minimum necessary and tells the young person what must happen and why. Frame the conversation with the family non-judgementally as a safety measure, not a punitive one. [6] [7]

SAQ 2 — Prevention tiering, evidence matching, and an immediate-safety exit (10 marks)

A. A school health team asks you to recommend a universal prevention program to reduce youth violence across a whole student cohort, and a selective program for a small group of disengaged, higher-risk students. [8] [4]

B. Separately, a 17-year-old presents to the emergency department after an overdose and is now medically stable; they have a firearm at home and describe passive suicidal ideation. [7]

Questions

1. Name an evidence-based universal prevention program and an evidence-based selective approach, justifying each by tier. (5 marks) [8] [4]
2. Outline your same-visit prevention actions for the post-overdose adolescent, including the disposition. (5 marks) [7] [6]

Model answer

Universal and selective prevention (5). For universal prevention, recommend a school-based social and emotional learning program delivered to the whole cohort; meta-analysis shows follow-up benefit on positive youth development and violence reduction, and it reaches every student regardless of individual risk. For selective prevention, recommend a targeted violence-prevention or mentoring program for the disengaged higher-risk group, plus structured positive-youth-development activities and, where indicated, a substance-use brief intervention. Indicated prevention (multisystemic or functional family therapy) would be reserved for young people already affected by serious violence. The discriminator is reach: universal = all; selective = higher-risk groups; indicated = already affected. [8] [4]

Post-overdose same-visit actions and disposition (5). Stabilise physiology first (airway, breathing, circulation, glucose, naloxone where opioid toxicity contributes). Then complete a same-visit suicide risk assessment — ideation, plan, intent, prior attempts, means access, protective factors, ability to keep safe. The immediate-safety exit is lethal-means counselling: counsel safe storage and arrange temporary removal of the firearm from the home before discharge, because the post-overdose period carries elevated near-term risk and the firearm is the most lethal means. Activate the crisis or mental-health pathway, build a written safety plan with who to call tonight, and do not discharge on a promise of safety alone or on delayed psychology. Disposition is urgent: mental-health or crisis pathway admission or close same-day wraparound with the firearm removed and follow-up loops closed. [7] [6] [3]