Adolescent risk assessment and harm minimisation — branching viva

Stem

The examiner will test whether you can defend harm minimisation as a clinical philosophy and run it under pressure. [3] [5]

Branch 1 — Philosophy

Examiner: Define harm minimisation. Is it the same as enabling? [3]

Strong answer: A pragmatic public-health stance that reduces the adverse consequences of a risk behaviour even when the behaviour continues. It is not enabling: a dead or HIV-positive adolescent cannot make any future change. Abstinence remains one option, not the only outcome. [3] [8]

Examiner: Why does abstinence-only fail here? [8]

Strong answer: The dual-systems model: reward matures before prefrontal control, so under peer and emotional load an adolescent may intend not to use and still use. Demanding willpower alone disengages the highest-risk youth. [8]

Branch 2 — Screening

Examiner: How do you screen for substance risk and for suicide? [2] [4]

Strong answer: HEADSS/HEEADSSS is the universal scaffold. Add CRAFFT or a frequency-based tool for substances when a lead appears; add ASQ or Columbia for suicide when mood is low. A positive screen is a trigger for same-visit clinical thinking, never a diagnosis. [2] [4] [5]

Branch 3 — Positive suicide screen

Examiner: A 14-year-old's ASQ is positive with a plan; they beg secrecy. [4]

Strong answer: Move from screen to full risk assessment: ideation, plan, intent, prior attempts, means, protective factors, ability to keep safe. Plan with intent crosses the override threshold for serious harm. Explain what must be shared and why, remove means, do not leave alone, activate crisis pathway. Do not rely on a promise of safety. [4]

Branch 4 — Opioid disclosure

Examiner: A 17-year-old took pills they thought were relaxers; fentanyl exposure is possible. What is the bundle? [6]

Strong answer: Take-home naloxone plus overdose education for the young person and, with consent, family or peers; safer-use messaging (no mixing, start low, never alone); opioid-use-disorder assessment and substitution-treatment linkage; needle-syringe access if injecting; blood-borne-virus testing. Non-judgemental, low-threshold. [6] [3]

Branch 5 — Confidentiality and systems

Examiner: The parent portal will show the naloxone plan. [5]

Strong answer: Modern confidentiality risk; use local sensitive-note workflows, minimise unnecessary disclosure, and check portal defaults so harm-reduction care is not leaked. [5]

Examiner extras

• Harm reduction keeps young people alive and engaged; engagement is itself an outcome. [3] [8]
• Name the method: motivational interviewing evokes change rather than imposing it. [7]
• State that local statute governs consent ages, reporting triggers and naloxone access — do not invent universal cut-offs. [5]