Adolescent consultation, HEEADSSS and confidentiality — branching viva

Stem

The examiner will test whether you can run a youth-friendly, confidential adolescent consultation under pressure, and act on what you find. [1] [4]

Branch 1 — Visit structure

Examiner: How do you open an adolescent consultation? [3]

Strong answer: Greet the young person first, by name, before the parent. Set a joint agenda. Introduce private time as a normal part of the visit. Do not take the sensitive history with the parent answering. [3] [2]

Examiner: Give your confidentiality line. [4]

Strong answer: Conditional confidentiality — 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. Say it up front, to both the young person and the parent, and offer to plan any override with the young person first. [2] [4]

Branch 2 — HEEADSSS

Examiner: Recite the eight HEEADSSS domains with one open question each. [1]

Strong answer: Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/mood, Safety. One open, non-judgemental question each, without assuming partner gender, orientation or activity. Note the original HEADSS (Cohen 1991) and the Eating and Safety expansion. [1]

Branch 3 — Screens

Examiner: A depression screen is positive — what next? [5]

Strong answer: Same-visit suicide-risk assessment and a disposition decision. Do not file for delayed review. Decide crisis pathway versus early review with a written safety plan based on ideation, plan, intent, means, prior attempts and protective factors. [5]

Examiner: What is CRAFFT for? [6]

Strong answer: A validated screen for adolescent substance-use risk. A positive result triggers further assessment and brief advice, not an automatic diagnosis or a reflex urine drug screen. [6]

Branch 4 — Emergency disclosure

Examiner: The 16-year-old discloses active suicidal intent for tonight and begs you not to tell anyone. [5] [4]

Strong answer: Active intent is a confidentiality override. Secure immediate safety, do not leave them alone, use the local crisis or emergency pathway, explain what must be shared and why, and share the minimum necessary. Do not keep an unsafe promise of secrecy. [4] [5]

Branch 5 — Systems and transition

Examiner: The contraception note will show on the parent's portal. [8]

Strong answer: Open-notes and portal transparency are a modern confidentiality risk. Use sensitive-note workflows, confidential contact details, and billing codes that do not betray content. Know your local portal controls and use them. [8] [4]

Examiner: A 17-year-old with a chronic disease has no adult provider. [7]

Strong answer: Transition is prepare–transfer–integrate in the medical home over years — assess readiness, build a portable summary, plan the move to adult care — not a birthday referral letter. [7]

Examiner extras

• Time alone is clinical quality, not optional courtesy. [3]
• The same-visit response to a positive screen is the pass/fail discriminator. [5]
• Never use a same-language family member as interpreter for sensitive disclosures. [4]
• Capacity to consent is assessed issue-by-issue, not by a single universal age. [4]