Start with a free account for 3 free CME credits. Already a subscriber? Sign in.

Teen Talk (HEADSSS/confidentiality)

Megen Vo, MD, Lisa Patel, MD, and Solomon Behar, MD
00:00
23:30

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

Sol and Lisa discuss the HEADSSS assessment and the role of confidentiality in the adolescent visit with Megen Vo, Clinical Assistant Professor at Stanford University.

  • The HEADSS goes from the least invasive to most invasive questions. It should be tailored to the age of the patient. 

  • Have parents step outside for the HEADSS exam. Laws vary by state, in California  minors over the age of 12 are permitted confidentiality around sensitive subjects.

    • Setting the stage can help parents be more accepting of this part of the exam. Dr. Vo recommends introducing the topic at 11 by saying, “next year,  I'm going to allow [child's name] to have some time alone with me for a couple of reasons: to have them practice talking with their doctor alone, to give them kind of more ownership over their health in that way, helping them transition from childhood to adulthood.”

  • At the beginning of the HEADSS discussion, inform the patient that this is a confidential exam. Evidence shows that teens feel more comfortable with providers who remind them of confidentiality.

  • Get a confidential phone number to contact the patient. 

  • H for Home:  who lives with you? Where do you stay? How do you get along with the people who are staying with you? Who do you get along with best?

  • E for Education: where do you go to school? What kinds of grades are you getting there? Have you thought about what comes after high school?

  • A for Activity:  who do you hang out with? How do you spend your time? What do you do to stay active? How do you stay connected with your friends?

 

Ed’s Note: the impact of social media on teen well-being cannot be emphasized enough, and should be included as part of the questioning of their ongoing activities.Questions might include:  How much time spent on it, how it makes them feel, and to ensure they are having face to face friend interactions

  • D for Drugs: are any of their friends starting to use alcohol, cigarettes, vaping, weed, prescription drugs etc? If positive, ask if they have tried any of the above substances and about  when they are using it and how they are getting access to it. 

 

  • S for Sex: when you think about yourself, do you think about yourself as a guy, a girl, something else, something in between, neither?  When you think about who you are attracted to, is it guys, girls, both, neither, something else? Have you ever done more than kissing with anybody? Have you ever felt pressured to touch anybody or be touched in a way that you did not want to? Did you consent to what happened?

  • S for Suicidality and Safety: how has your mood been? Have you ever thought about hurting yourself or anybody else? Has anyone ever hurt you, hurt your feelings, hurt you physically, touched you in a way that you did not want to be touched? 

  • In California, adolescents can seek confidential treatment and testing for substance abuse. Additionally, contraception is covered under confidentiality law in California. 

    • Family PACT is a confidential method to have care covered.  Planned Parenthood is also available to provide confidential care. 

  • In general, mental health treatment, not including medications, remains confidential if that is the patient’s preference. 

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
Hippo Peds RAP November 2021 Written Summary 2 MB - PDF

To earn CME for this chapter, you need to subscribe.

Sign up today for full access to all episodes and earn CME.

0.25 Free AMA PRA Category 1 Credits™ certified by Hippo Education

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate

3.25 AMA PRA Category 1 Credits™ certified by Hippo Education

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate