1. Communicating with Adolescents Nigel Mills Adolescent Nurse Specialist GOSH Blp 2066

2. Outline What’s an adolescent? What’s an adolescent? Communicating with Adolescents Communicating with Adolescents DVD DVD HEADSS Assessment Tool HEADSS Assessment Tool

3. Definitions Adolescent 10 to 19 years Adolescent 10 to 19 years Young person 10 to 24 years Young person 10 to 24 years Youth 15 to 24 years (WHO) 7.8 million adolescents in UK in 2007 7.8 million adolescents in UK in 2007 12.8% of the population 12.8% of the population (Key data on adolescents 2009) Adolescent CNS @ GOSH 11 (Secondary School) to ? years

4. Defining Adolescence Defining adolescence chronologically has limitations Divided into stages: early (c10-13), mid (c14-17) and late adolescence (c17-?) Developmental tasks associated with adolescence –Transition between childhood and adulthood –Moving on a continuum towards independence

5. ‘a variable period between childhood and adulthood, largely bounded by 10 and 20 years of age, characterised by rapid development in psychological, social and biological domains’ Bridging the Gaps, 2003 Adolescence Defined

6. Psychosocial development (D Christie & R Viner in ABC of Adolescence) BiologicalPsychologicalSocial Early Adolescence 10 to 13 years “on stage” Early puberty (girls: breast bud, pubic hair, growth spurt; boys: testicular enlargement, genital growth) Concrete thinking but early moral concepts; progression of sexual identity development (orientation); possible homosexual peer interest; reassessment of body image Emotional separation from parents; start of strong peer identification, early exploratory behaviours (smoking, violence) Mid- Adolescence 14 to 17 years “peers” Girls: mid-late puberty and end of growth spurt; menarche; development of female body shape with fat deposition Boys: mid-puberty; spermarche and nocturnal emissions; voice breaks; start of growth spurt Abstract thinking, but self still seen as “bullet proof”; growing verbal abilities; identification of law with morality; start of fervent ideology (religious, political) Emotional separation from parents; strong peer identification; increased health risk (smoking); heterosexual peer interest; early vocational plans Late adolescence 17 – ? years “separation” Boys: end of puberty; continued increase in muscle bulk and body hair Complex abstract thinking; identification of difference between law and morality; increased impulse control; further development of personal identity Development of social autonomy; intimate relationships; development of vocational capability and financial independence

7. Why communicate differently with adolescents? Adolescents have evolving health needs – very rapid development- that are different to those of children and adults Adolescents have evolving health needs – very rapid development- that are different to those of children and adults Continuum of developing independence: from dependence of family towards independence and identification with peer group Continuum of developing independence: from dependence of family towards independence and identification with peer group Developing different cognition skills: concrete to abstract Developing different cognition skills: concrete to abstract Standard paediatric assessment / interview is inappropriate for this group of patients Standard paediatric assessment / interview is inappropriate for this group of patients Requires more time – take longer to digest information Requires more time – take longer to digest information

8. Communicating with adolescents Be aware of body language (yours and theirs) position is power. If parent there where have they sat? (‘Gatekeeper’) What’s the dynamic / atmosphere with parents like? Who have they argued with? Be yourself, friendly and approachable but remember boundaries - don’t be too personal Take an interactive approach, no-one likes being interrogated Be honest if you don’t understand dialogue clarity is all important Be aware of how you phrase questions/statements

9. Communicating with adolescents Listen carefully and show interest in answers Take ‘third person’ approach How tired are they? different body-clock, need more sleep Sometimes a good time for you isn’t a good time for them Don’t make assumptions, be non-judgmental Preferably see without parents for some of time (especially if you want honest answers!)

10. Communicating with adolescents My mum’s beside me… “Are you sexually active?” You’re just like: my mum! Me and my mum! I don’t wanna answer. It’s like: do you smoke, do you take drugs? Are you an alcoholic? You don’t wanna answer to that in front of your mum!’ female, 14 years female, 14 years

11. Communicating with adolescents Treat as an individual Respect concerns and opinions Remember that it may take time for them to trust / like you enough to open up Be aware of history - they may not trust adults / professionals. And you are going to stick a needle in them. Think who else has asked these questions – it’s boring repeating yourself Progress from neutral to more sensitive topics / build a rapport (HEADSs)

12. HEADSS H- home H- home E – education/employment (eating and exercise) E – education/employment (eating and exercise) A – activities A – activities D - drugs D - drugs S - sex S - sex S – suicide and depression, safety, spirituality S – suicide and depression, safety, spirituality Goldenring & Cohen 1998

13. HEADSS provides :- An opportunity to develop a relationship and rapport An opportunity to develop a relationship and rapport A guide to future interventions A guide to future interventions A method of risk assessment A method of risk assessment

14. HEADSS Interview tips Interactive rather than interrogative Interactive rather than interrogative Listen carefully Listen carefully Check language Check language Progress from neutral to more sensitive topics Progress from neutral to more sensitive topics Take ‘third person’ approach Take ‘third person’ approach Respect the young person’s concerns & points of view Respect the young person’s concerns & points of view

15. HEADSS Interview tips best practice: using HEADSS when young person is well best practice: using HEADSS when young person is well ‘other adults should not be present when HEADSS used’ unless…. ‘other adults should not be present when HEADSS used’ unless…. setting the scene: confidentiality young person central to interview

16. HEADSS - Home Who lives with YP ? Where? Who lives with YP ? Where? Own room or shared? Own room or shared? What are relationships like at home? What are relationships like at home? What do parents/carers do for living? What do parents/carers do for living? Any recent moves? Running away? Any recent moves? Running away? New people in home environment? New people in home environment?

17. HEADSS- Education & Employment Likes/dislikes school ? Performance? Likes/dislikes school ? Performance? Favourite subjects, worst subjects? Favourite subjects, worst subjects? Likes/doesn’t like teachers ? Likes/doesn’t like teachers ? Suspensions/dropping out of lessons? Suspensions/dropping out of lessons? Changes in school? Changes in school? Further education/career goals? Further education/career goals?

18. HEADSS- Activities Fun with peers? When/ where? Fun with peers? When/ where? Activities with clubs or family? Activities with clubs or family? Sports-regular exercise? Sports-regular exercise? Hobbies –other home activities? Hobbies –other home activities? Reading for fun/TV/Computer games? Reading for fun/TV/Computer games?

19. HEADSS- Drugs Use by peers? Use by peers? Use by young person (tobacco, alcohol)? Use by young person (tobacco, alcohol)? Amounts, frequency, patterns? Amounts, frequency, patterns?

20. HEADSS-Sexuality Degree and types of sexual experience? Degree and types of sexual experience? Orientation? Orientation? Number of partners? Number of partners? Contraception and knowledge of STD’s Contraception and knowledge of STD’s Comfort with sexual activity Comfort with sexual activity

21. HEADSS-Suicide Sleep disorders? Sleep disorders? Appetite/eating behaviour changes? Appetite/eating behaviour changes? Hopeless/helpless feelings? Hopeless/helpless feelings? Self harm/suicide attempts? Self harm/suicide attempts? Suicidal ideation? Suicidal ideation? Affect in interview? Affect in interview?

22. Help is out there Hospital play staff Hospital play staff Nurses Nurses Nurse specialists Nurse specialists Allied health professionals Allied health professionals Student nurses Student nurses Parents Parents

23. Help is out there GMC guidelines for 0 to 18 year olds: GMC guidelines for 0 to 18 year olds: ‘Effective communication between doctors and children and young people is essential to the provision of good care. You should find out what children, young people and their parents want and need to know, what issues are important to them, and what opinions and fears they have about their health or treatment….’ ‘Effective communication between doctors and children and young people is essential to the provision of good care. You should find out what children, young people and their parents want and need to know, what issues are important to them, and what opinions and fears they have about their health or treatment….’