JC Suris

1. Interviewing the adolescentJC Suris, MD, MPH, PhDLausanne University HospitalSwitzerlandjoan-carles.suris@chuv.ch

2. JCSuris Has documented that he/she has no relevant financial relationships to disclose or COIs to resolve. • JCSuris has documented that his/her presentation will not involve discussion of unapproved or off-label, experimental or investigational use.

3. Learning objectives • To be aware of the specific characteristics of interviewing adolescents • To describe and show proficiency in effective communication with adolescents • To skillfully use the interview to build partnerships with the adolescent patient and his/her parents

4. Outline • A few differences • Having a plan in mind • Using the HEEADSSS • A few [useful] tips • How to communicate with adolescents • What to do and what to avoid • Getting in situation: role-playing

5. A few differences • Confidentiality and its limitations • The [new] role of parents

6. Having a plan in mind

7. FIVE BOXES PHYSICAL HEALTH HOME SCHOOL/ WORK PEERS ROMANCE Brown et al., Sem AdolescMed 1987

8. SAFE TIMES • Sexuality • Affect/Abuse • Family • Exam • Timing of development • Immunizations • Minerals • Education, Employment • Safety Schubiner et al, J Adol Health 1994

9. Goldenring & Rosen, Contemporary Pediatrics, 2004

10. HEEADSSS Home Education Eating Activities Drugs Sexuality Suicide Safety • H • E • E • A • D • S • S • S

11. HEEADSSS:Some suggested questions

12. HOME • Where does the adolescent live? • With whom? • Siblings? • Family ambiance? • Moved lately?

13. EDUCATION/WORK • School year • Academic performance (changes?) • Relationship with teachers/colleagues, changed school? • Does he work? Where? How many hours? Since when? • Relationship with co-workers/boss • Future projects

14. EATING • What does s/he eat? • How many meals? Skips meals? • Who does s/he eat with? Who prepares the meals? • Weight changes • Diet? Other methods to control weight? • Body image

15. ACTIVITIES • What does she do with her friends/family for fun? • Sport or physical activity (type and frequency)? • Hobbies • Relationship with friends?

16. DRUGS • Do his friends/his family/himself use tobacco/ alcohol/cannabis/other drugs? How often? • Does he use drugs alone or with friends? • Does he use drugs before going to school/work? At school/work? • Drug problems within the family? • Ever driven (ridden) a vehicle while intoxicated?

17. SEXUALITY • Partner? • Partner’s age? • Sexual intercourse (if yes, age at first)? • Type of contraception? • Number of partners? • Ever pregnant? Ever STI? • For girls: age at menarche, date of last periods

18. SUICIDE / MENTAL HEALTH • How does s/he feel? • Feeling sad? • Having trouble to sleep? • Lack or excess of appetite? • Suicidal ideation? If yes, does s/he have a plan? Talked to anyone about it?

19. SAFETY / VIOLENCE • Uses helmet / seat belt? • Ever had an accident (type, when, sequels)? • Ever drove (rode) a vehicle while intoxicated? ? • Violence [verbal, physical] at home/at school? • Sexual or physical abuse, mobbing... • Delinquency…

20. A few [useful] tips

21. Sleeping problems Feeling sad, depressed Problems with tobacco Problems with alcohol/drugs Problems with sexuality Needs and consultations: 16-20 year-olds, Switzerland, 2002 Neeeding professional help % having consulted M F 14% 23% 19% 35% 22% 18% 15% 7% 11% 9% M F 8% 10% 3% 7% 4% 3% 3% 3% 4% 29%

22. Independently ofthe reason for consultation,don’t miss the opportunity!

23. Asking the right questionsis not enough.... You also needthe right optionsfor their answers!

24. Time….

25. HEEADSSS Home Education Eating Activities Drugs Sexuality Suicide Safety • H • E • E • A • D • S • S • S

26. Always have a good reasonfor every question you ask

27. Remember: If you don’t ask the question... You’ll never know!

28. How to communicate with adolescents • Have a conversation, not an interrogatory • Be specific • Clarify concepts • Summarize periodically • Avoid medical jargon • Avoid closed questions • Give the impression that nothing can surprise anymore

29. Tips: DO • Go through the chart/referral notes before seeing the patient • Go to the waiting room to fetch the patient • Introduce yourself by name, shake hands if appropriate • Once in the office, present yourself and what you do • Assure confidentiality • Define the meaning of words • Be professional

30. Tips: DO • Let the patient tell his/her story without interruptions as much as possible • Then use open-ended questions to clarify • Listen in a non judgmental manner • Ask questions in a non threatening way, have a conversation • Accentuate the positive • Have a good reason for each question • Summarize the conversation

31. Tips: AVOID • Medical jargon • Yes/No questions • Being one of the gang: they’re looking for a professional! • Doing an interrogation • Asking what you don’t need to know • Writing down during the interview/ Checking record

32. THE WALL(when your patient does not want to talk) • Keep talking allow him/her to be silent • Start with closed questions • Explore possible interest areas • Use the physical exam as an opportunity • After talking (or not!) with the patient for a while, imply the parents L’entrevista

33. Some cases to role-play

34. Case 1 • You are a 14 year-old girl that since 2 weeks complains of abdominal pain. • You smoke a few cigarettes per day even though your mother (who is a former smoker ) does not want you to. • You have a boyfriend 2 years older than you with whom you are sexually active, always using a condom except for the last time (2 weeks ago) and you are afraid you may be pregnant. You DO NOT WANT your mother to know that you are sexually active. For this reason, you will only tell the health professi0onal if s/he assures you that the interview will be confidential.

35. Case 2 • You are a 13 year-old boy sent to the consultation by the school nurse because of headaches (2-3 per week) that force you to stay at home and miss your classes. The headaches are easily handled with paracetamol. • Your grades are not good and missing so many classes does not help at all. • Additionally, some of your classmates make fun of you because of your weight (70kg) for a height of 153 cm. In fact you don’t want to go to school because your classmates bully you, but you do not want your parents to know. For this reason, you will only tell the health professi0nal if s/he assures you that the interview will be confidential.

36. Case 3 • You're a 17 year old boy who needs a certificate to play football. Your studies are going well, no problems at home. No smoking or drinking, but occasional cannabis use with your teammates. • You do 3 training sessions + 1 game per week and you are a little tired. Your coach offered you to take a "vitamin" but you do not know what to do. • Additionally, you are a bit tired of playing football and would like to do something different, but your father (a former player) pushes you to play and you do not want to deceive him. For this reason, you will only tell the health professi0nal if s/he assures you that the interview will be confidential.

37. Case 4 • You're a 17 year old girl coming at the request of your mother because she believes that you are too thin and you do not eat enough. You lost 5 kg in one month. • Currently you weigh 45 kg and you measure 161 cm. You had your menarche at age13. Your periods are very regular but the last ones were 6 weeks ago. • You do not do vomit and you do not take laxatives, but you always choose low calorie foods. You do one hour of fitness 5 times a week. For this reason, you will only tell the health professi0nal if s/he assures you that the interview will be confidential.

38. Some take-home messages

39. Some take-home messages • Assure confidentiality • Have a plan in mind • Have a conversation • Explain what you do • Be a professional • Accentuate the positive

40. THANK YOU!