Engaging Adolescent-Headss Framework

Engaging Adolescent-
HEADSS FRAMEWORK
Adolescent
An adolescent is a youth is a young person…

Adolescence 10 – 19 years
Youth 15 – 24 years
Young people 10 – 24 years
WHO (World Health Organization), UNICEF (United Nations Children’s Fund),

UNFPA (United Nations Population Fund); 1988
Engaging
• Building of rapport between Health Care

Provider & clients.
• It involves the adjustments Health Care
Provider must make in their approach to
encourage clients to feel health care is worth
having & worth returning for.
The importance
• Finding out what is important to them.

• To identify individual risk factors.
 Mortality & morbidity.
 Co-occurrence of risks.
 Contribution to adult burden of disease.
• To identify key socialising influences.

• To identify factors that may promote resiliency.
The importance
• To be able to effect an individual pathway for early intervention

of risk(s).
• Exploration of psychosomatic disorders.
• Prevention & anticipatory guidance.
• Health promotion.
The Importance..
• “You don’t know until you asked!”

• Young people worry that they would not be understood, or
taken seriously, or maybe judged.
• Adolescents are less likely to volunteer information unless
directly asked…
 Fear of being “found out”.
 Fear of being judged & told off.
 Lack of understanding of confidentiality issues.
Confidentiality
• Ethical requirement to maintain confidentiality
when requested by a mature minor who is
assessed as competent.
• All information should be regarded as confidential
until discussion & negotiation has taken place.
• A clear statement at the beginning of contact with
an adolescent that explains confidentiality policy
with exceptions is important.
Confidentiality
Confidentiality
Increased comfort
Less anxiety
Increased trust
Feeling of connectedness with doctor
More willing to disclose information

More honest about disclosure
Increased likelihood of future visits
Confidentiality
Promising confidentiality
• Balancing the rights of the young person to confidentiality
& the need for safety & meeting obligations to parents &
the law.
• How much confidentiality can you promise?
• 3 exceptions – If I believe that you….
 Are at risk of physical or sexual abuse.
 Are going to seriously harm yourself.
 Are going to seriously harm others.
Clinical Approach
• See the young person on their own.

• Explain confidentiality i.e. the 3 exceptions
• Explain your process.
 Who you are.
 What you are doing.
 Why you are doing it.
• HEADSS assessment
Tips on Engaging
• Introduce yourself to the young person first.

• Explain who you are & what you do.
• Get them to introduce accompanying others.
• Negotiate for some time alone;
 See parents & young person together, then young
person alone, then reconvene.
Tips on Engaging
• Compliment them on turning up.

• Compliment them on an aspect of their person
e.g. appearance.
• Find out what is important in their lives.
• Let them teach you something e.g. “tell me what
hanging out are like for young people
nowadays”.
Tips on Engaging
• DO NOT use jargon.

• Appear UNHURRIED even if time is limited.
• Be open, honest & flexible.
Tips on Engaging
• Active listening.
▫ This allows the young person to explore their
thoughts & why they think that way.
• Minimal verbal & non-verbal encouragement.
• Probing questions.
• Clarification.
• Reflection.
• Multiple choice question.
HEADSS
1. Psychosocial assessment tool

a. Negative factor(s)  risk/morbidity
b. Positive factor(s)  connectedness/relationship
2. Engagement tool
3. Assessing progress
• Developing rapport with the young person while
systematically gathering information about their world .
• Performing risk assessment and screening for specific
risk behaviors
• Identifying areas for intervention and prevention
• Developing picture of the young person’s strengths and
protective factor
• Assessing progress of the young person’s psychosocial
problem post intervention
HEADSS
• Home
• Education/Employment (Eating & Exercise)
• Activities & Peer relationships
• Drugs/Cigarettes/Alcohol
• Sexuality
• Suicide/Self-Harm/Depression/Mood (Safety/Spirituality)
HEADSS - Home
• Where do you live?

• Who lives with you?
• How do you get along with each member?
• Who could you go to if needed help with a problem?
• Have there been any recent changes?
HEADSS – Education/Employment
• What do you like about school?
• How much school have you missed in the last 3
months?
• What are you good/not good at?
• How do you get along with teachers & other students?
• Have your grades changed recently?
• Many young people experience bullying at school,
have you ever had to put up with this?
• What are your future plans?
HEADSS – Activities & Peer
relationships
• What sort of things do you do in your spare time
out of school?
• What do you like to do for fun?
• Tell me about parties?
• Do you belong to any clubs, groups etc.?
• What sort of things do you like to do with friends?
• How much TV do you watch each night?
HEADSS –
Drugs/Cigarettes/Alcohol
• Many young people at your age are starting to
experiment with cigarettes or alcohol.
• Have any of your friends tried this or maybe other
drugs like marijuana, IV drugs & ecstasy?
• How about you, have you tried any?
• What effects do drug taking, smoking & alcohol have
on them/you?
• Do they/you have any regrets about taking drugs?
• How much are they/you taking & how often, & has used
increased recently?
HEADSS - Sexuality
• Some young people are getting involved in

sexual relationships, have you had a sexual
experience with a guy or girl or both?
• Has anyone touched you in a way that has
made you feel uncomfortable or forced you
into a sexual relationships?
• How do you feel about relationships in general
& about your own sexuality?
HEADSS – Suicide/Self-Harm/
Depression/Mood
• How do you feel in yourself at the moment on

a scale of 1 to 10?
• What sorts of things do you do if you are
feeling sad/angry/hurt?
• Is there anyone you can talk to?
• Do you feel this way often?
HEADSS – Suicide/Self-Harm/
Depression/Mood
• Some people who feel really down often feel like

hurting themselves or even killing themselves, have
you ever felt this way?
• Have you ever tried to hurt yourself?
• What prevented you from doing so?
• Do you feel the same now?
• Have you a plan?
What if they don’t talk?
• Reduce the focus on the person.

 “Some young people have tried smoking…”
• Give them a choice of answers.
 “It seems to me that you are feeling frustrated or do
you feel angry?
 “Have you tried other drugs such as speed, ecstasy,
or cocaine…”
Other useful questions structures..
• Suggest an explanation & invite them to agree or

disagree.
 “You may disagree with this but it seems to me that
you feel upset with your parents for…”
• Scaling
 “Give school a mark of 10.. If 10 is great & 1 is
terrible, how do you rate school?”
Supporting growing maturity…
• Give them developmentally appropriate

information.
• Dispel any myths.
• Use their interests to help motivate.
• Getting them to make the decision.
Case Discussion
16 years old male, non local , uneducated. Stay alone in rental room in Batu 7 ,Sandakan.
Brought in to JPL by social worker ,with complaint of oral ulcer for past 1 week. He has been stressful thinking
of his possible diseases.

On further history , he was born in Tawau and previously living with his parent other 4 sibling . The eldest
sibling is 20 years old and youngest is 8 years old. His father works as laborer while mother is housewife. He
claims having good relationship with family members and recently come back visiting his family on march .
He has been moving alone to Sandakan for the past 2 years for working .

He is a smoker , started 2 years ago , 1 pack per day, didn’t drink alcohol and not taking drug. He got a tattoo
over left forearm since months ago .
He has been involving in high risk sexual activity for past 2 years , working as sex worker and been having
multiple sex partners with same gander.

HIV rapid test taken and found out to be positive. Hence ,another blood sample was send for confirmatory
test.

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Engaging Adolescent-

An adolescent is a youth is a young person…

WHO (World Health Organization), UNICEF (United Nations Children’s Fund),

• Building of rapport between Health Care

• Finding out what is important to them.

 Contribution to adult burden of disease.

• To identify key socialising influences.

• To be able to effect an individual pathway for early intervention

• “You don’t know until you asked!”

More willing to disclose information

• See the young person on their own.

• Introduce yourself to the young person first.

• Compliment them on turning up.

• DO NOT use jargon.

1. Psychosocial assessment tool

• Where do you live?

• Some young people are getting involved in

• How do you feel in yourself at the moment on

• Some people who feel really down often feel like

• Reduce the focus on the person.

• Suggest an explanation & invite them to agree or

• Give them developmentally appropriate

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