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When HEEADSSS conversations with young people are crucial

Prof Kate Steinbeck: HEEADSSS is a way of getting a comprehensive picture of a young person's world.

Graham Lane: It's a psychosocial screen tool, so you're talking about the things that influence people's lives.

Andre Zeballos: More often than not, the young person are coming with one issue, but as you're having that conversation, you'll realize that there's a whole number of contributing factors that maybe even the young person isn't quite aware of.

Voice over: When HEEADSSS conversations with young people are crucial.

Dr Melissa Kang: I was quite a junior doctor working in an emergency department, and there was a fourteen-year-old girl in a bed with an oxygen mask on with the diagnosis of asthma. I started talking to her, started to take a HEEADSSS history, and I think that engaged her in a conversation. By the time we got to talking about sex, she actually admitted to me that she thought she was pregnant or she just found out she was pregnant. She was having a panic attack and hyperventilating, and that's the reason she'd come into hospital. So we were able to actually change tack and, you know, give her the treatment and management that she needed.

Prof Kate Steinbeck: Often I'm going to be the only person who's going to directly ask those questions of that young person. And then if I get answers, I have the capacity to act and act in a timely way.

Graham Lane: The thing about working with young people is that it's important to engage them in a conversation.

Kate Tolley: Sometimes a young person might not have the the tools to communicate what's really going on for them.

Dr Melissa Kang: I always find it important to build trust and to have engagement. I think that actually should be the first goal when you're seeing an adolescent patient. Doctor: Are you feeling OK? Young person: Yeah, I am a bit anxious. Doctor: Yeah? Feeling a bit nervous. That's understandable. You don't know me. First time we've met, yeah. That's all right. So you are happy if I ask you a few questions? Young person: Yeah.

Dr Melissa Kang: Of course HEEADSSS is actually more than that. It's about assessing risk and protective factors because the health problems of young people are often around health risk behaviors.

Andre Zeballos: So, by having that conversation, you're kind of able to bring that out while building the relationship at the same time.

Dr Jane Ho: I think there are barriers at different levels.

Andre Zeballos: A lot of workers feel stressed, pressed for time. You know, how can I have a conversation when there's 10 million things in the back of my mind that I need to do?

Dr Jane Ho: Often for general practitioners, they have long lists of people who are waiting to see them. Everybody's urgent.

Dr Melissa Kang: But you don't have to do it all at once. You can start, move around in it, come back to it at another time.

Andre Zeballos: Just taking five minutes to finish two of the questions, you know, knowing that it can be a work in progress.

Dr Melissa Kang: Clinicians often worry that, by the time they get to some of the more sensitive parts of HEEADSSS, that they're going to open a can of worms, that they might not be equipped to actually deal with what the young person is going to reveal. And it can create a lot of anxiety on the part of the clinician. And there's often a concern to get to the presenting problem, to deal with the presenting symptoms and get to a diagnosis rather than taking a step back and saying, "Well let's broaden the line of inquiry here".

Dr Jane Ho: "But I think the important thing to remember is that, I think, the biggest barrier is in our own heads. And that's not a pun...that was a pun.

Dr Melissa Kang: If you're getting ready to start having a HEEADSSS conversation with a young person, it's really important for clinicians to be aware of how they're feeling.

Kate Tolley: So make sure I'm in the right frame of mind, acknowledging what you're not comfortable with. So, it might be that, before you even ask the questions, that you might need to go away and do a little bit of research or discussion with your peers first.

Prof Kate Steinbeck: I think it's always important as the clinician to remember truly what adolescence was like. Not knowing what you wanted to say, being worried what you might sound like, all that self-consciousness, and embarrassment of being an adolescent. And the sensitivity and the need for privacy. I think it just reminds us to not push too hard.

Graham Lane: You need to take into consideration what is actually happening around you and what's happening around the young person in whatever setting you're in. And to make sure that people are comfortable, it's best if you can make it private.

Dr Melissa Kang: Create a warm and welcoming and trusting place for the young person and for yourself as well. Because once you've done it once or twice, it actually can become absolute second nature when you're talking to a young person.

Voice over: The next video is What a young person may bring to the conversation. It covers: Stages of adolescent development; If trauma is disclosed, what to do; Identifying protective factors; and approaches for different stages of development.


What a young person may bring to the conversation

Dr Melissa Kang: I think there's a really common perception by clinicians that young people don't want to talk to you, that they're hostile and angry, and I find that a little bit unfair. I think it's really important just to say to yourself it's normal for a teenager not to want to open up. They don't trust you yet. You haven't engaged them yet. Or remember what it was like when you were a teenager - would you have opened up to a complete stranger? If you're feeling frustrated or angry, just check that, because that's going to get in the way, in fact, of engagement. Think about what the young person's going through, and then you can start the conversation just gradually and patiently.

Overlay: What a young person may bring to the conversation.

Dr Melissa Kang: What often we feel, that young people are a bit resistant, they're a bit hostile towards us, or perhaps they look really anxious, and a really good technique for dealing with that immediately is to actually try and name the feeling that's in the room. So perhaps just making a comment that they seemed rather angry or they seemed a bit anxious. How are they feeling? And even just naming that and putting it out on the table often overcomes that barrier and allows the conversation to continue.

Doctor: You're looking a bit down, not as happy as you usually are. Do you want to tell me what's going on?

Dr Melissa Kang: Yeah. Um, there has been a couple of things on my mind.

Dr Melissa Kang: Young people often are really desperate to tell you something. They're just checking you out first, and and they decide when it's time and they're ready to tell you.

Jacqui: And if there's one thing that I can say out of all this now, after talking about everything... you've really need to know how to active listen. You really need to.

Mark: It does happen sometimes where the person tries to be too cool and it gets a bit awkward. So make sure not to get too cool.

Dr Melissa Kang: A really important way of assessing a young person is to understand adolescent development, and to understand that development kind of takes place in about three different sub-stages. And that those different stages there are different things to look out for. So we know, for example, that risk-taking behaviour starts around the middle of adolescence. Someone who starts puberty much younger might go through that middle part of adolescence and risk-taking a bit earlier. Whereas someone might not do any risk-taking, or it might happen much later, age-wise.

Prof Kate Steinbeck: So when you're talking to 12- to 13-year-olds, they're pretty concrete thinkers, keep it simple, keep the sentences short. They don't really have a very good idea of the future. The future to them is the weekend. Later teens, their brain has certainly progressed. They are able to think more in abstract concepts. They are already thinking a little bit about the future. They they're able to plan a bit better. They're able to understand the importance of routines. And of course use your common sense. Not all 15 year-olds are identical, and it's important to take into account things that might interfere with communication, like a young person is stressed, sick, have mental health problems.

Dr Melissa Kang: So we're not always sure where a young person's up to with their understanding and their maturity. And HEEADSSS can help guide that, help us guide that assessment. But what we can do really, is ask a young person to check in with them. Ask them what they understood by what we just said. So have a bit of a conversation about that. So, when I'm talking to a young person there's always going to be a chance that there's some trauma in the background. It can take many different forms and guises, and it might not be obvious straightaway. Any trauma that's happened, significant trauma in a child or adolescent's life can have a really significant and sometimes lifelong impact on their mental health, on their physical health, on their relationships, all sorts of things. The goal of HEEADSSS is certainly not to get a disclosure of trauma. So if a young person actually does reveal something that's been traumatic, the important thing for me is not to panic, just to listen, to acknowledge it and let them talk about it if they want to. And also to make sure that they actually feel safe now and that they're going to be safe when they leave my room.

Young person: A friend of mine passed away recently. Yeah.

Doctor: Oh, I'm so sorry to hear that. Sounds like things are really tough at the moment.

Young person: Yeah.

Doctor: How did it happen?

Young person: She killed herself.

Doctor: Oh, gosh that is an absolute shock. No wonder you're feeling so low at the moment. Can I ask you a bit more about how low you're feeling?

Young person: OK

Doctor: Have you been feeling so low that you know you're not feeling safe, that you've had thoughts about wanting to hurt yourself?

Young person: No, I am just finding it hard to deal with, but I haven't thought about that.

Doctor: OK. So how have you been dealing with it, how have you been helping yourself?

Dr Melissa Kang: Another thing that I try to do when I'm taking a HEEADSSS history is to inquire about protective factors. So those are the things in a young person's life that's going to bolster them.

Kate Tolley: I look for things that are going well for young people, and think about how can we build up upon that so that it starts to trickle across the other aspects of their life. So for me it might be thinking about, you know, do they have at least one adult in their life that they can communicate with and feel safe with?

Andre Zeballos: With young people, it can be quite challenging for them to find their own strengths, you know? So I'm constantly kind of scanning the conversation for areas where they might, you know...identify something that I can take away and say, "Hey, look, you know that was a real strength of yours." Young people really value it when you're reflecting back on some of their strengths.

Dr Melissa Kang: Young people are really, really clear that they notice when a clinician is being judgmental, but I'm often asked by clinicians, "Well, if a young person discloses that they're doing something that's really dangerous or unsafe or you just think is somehow wrong how do you approach that without coming across as judgmental?" So, a really good example would be something like a young person who tells me that they got drunk on the weekend and they got into a car with someone or they had unprotected sex. And I might think to myself, "Well, that sounds you know, silly or stupid, even, or risky." And the important thing then when you're communicating that to the young person is not to make that judgement, because in fact that's my judgment.

Kate Tolley: So I think the difference is when we understand an issue we might take into consideration how that young person's got to that position, what their previous experiences have been.

Dr Melissa Kang: And the process then is to get them to reflect on that and come up with their own judgment about it. I will always, though, point out, what some of the health consequences can be, and have a conversation with them about that.

Young person: we usually get pretty hammered actually. Healthcare worker: Yeah, OK. And would you do that at a pub or at a mate's house?

Young person: Yeah, usually at the pub. Healthcare worker: Yeah, and how would you normally get home from a night out?

Young person: Sometimes my mates drive me, sometimes I just walk. Healthcare worker: Yeah, OK.

Dr Melissa Kang: What I find helpful is to keep an open mind, to listen and probe and explore rather than kind of being tempted to rush in with facts or lessons straightaway. Trust is actually the key to everything. If you can gain their trust, then everything else will follow. So really focus on that in the first instance.

Andre Zeballos: And again, you know, just reminding yourself to be honest with a young person, and that, you know, again you're not going to capture everything in the first conversation.

Voice over: The next video is Useful tips for HEEADSSSs conversations. It covers: Techniques for starting conversations; Tips for parent conversations; and Navigating the discussion.


Useful tips for HEEADSSS conversations

Dr Melissa Kang: HEEADSSS isn't there to make us feel all hung up and nervous and anxious. It's just a framework. it's just a guide to having a conversation. So try and think about it that way. And it can be used very flexibly.

Voice over: Useful tips for HEEADSSS conversations.

Dr Melissa Kang: So HEEADSSS is the kind of conversation that you can actually have in any kind of setting depending on what the situation is. So in a community setting, when you've got a bit more time and you're actually there to do a health assessment, it really should be routine that you start a HEEADSSS conversation at some point in time. If it's an acute situation, like an emergency department or a busy hospital outpatients, it might feel a bit harder to do that, but you can still find opportunities to start a HEEADSSS conversation.

Kate Tolley: I really like to get it going as soon as they're comfortable and you know they're not in pain or anything. And the reason being, I think in hospitals more and more we see quite a rapid turnover. We don't want to leave it til they're headed out the door to maybe pick up some potential worries or complications.

Dr Melissa Kang: The first thing is that it really is important to try and have a little bit of time alone with most young people. And there are different ways to do that. So I like to set it up before I even see them for the first time, so when they ring up and make an appointment it's explained to the parent perhaps, over the phone that the doctor will spend some time alone with the young person. But if the parent comes into the room, which often happens, into the consultation room, then I'll set that up at the beginning and I'll explain a couple of things. One is that I always see young people by themselves for some of the time, and so I normalise that behavior.

Doctor: OK, so what I'd like to do now Robyn, is spend a little bit of time alone with Sarah. I do this with all the young people that I see once they've reached about highschool onwards. I spend a few minutes of the consultation by ourselves, just giving them an opportunity to chat with me. I think it helps young people learn to communicate with health professionals, learn to take responsibility for their health. But what I'd like to do is I'll bring you back in at the end that we can wrap things up. Would that be okay with both of you?

Young person and Mum: Yeah

Mum: That's alright with you?

Young person: Yep.

Mum: OK.

Doctor: Good, thank you.

Mum: Sure.

Andre Zeballos: And then again, extending it to the young person, just saying, "Oh, What would you like? Would you like your mum to sit in with you? If not, we're happy to have a conversation one on one. You might find it's a bit more comfortable if you're wanting to talk about more sensitive issues".

Dr Melissa Kang: So when I kick off a HEEADSSS conversation, I always introduce it, just a little bit of a preamble with the young person.

Doctor: So, Sarah, what we're going to do today is have a bit of a chat. I'm going to ask you a few questions about anything that's worrying you about your health. But before I do that, I'd just like to explain confidentiality to you. What I mean by that is that anything you tell me is just between you and me. I can't tell anyone else, I can't go and tell mum, OK, without your permission. But there are a couple of exceptions to that, and one is if I'm really worried that you're about to go out and seriously hurt yourself or somebody else, or if someone else is hurting you, then I have a duty to keep you safe and that might mean that I have to involve other people. Is that oK?

Young person: Yeah, that's fine.

Dr Melissa Kang: Ask open-ended questions, so let the young person talk about whatever it is that is concerning or of interest to them, rather than me having a fixed idea of what I have to ask. And the other is to let them guide the questions that I ask to some extent, so their conversation is guided by how they respond, and I go in that direction or another direction. So, really just to let that conversation flow according to them.

Mark: I think what's the most important thing to be comfortable talking with a doctor is knowing that there's someone you can trust. The best way that you can earn a patient's trust is to get to know them a bit more personally, knowing that... you know, it's asking the questions "How's your day? How's your weekend? Any plans in the future?"

Andre Zeballos: I do think, you know, starting with some of the softer questions - "What are your hobbies and sports and interests?" And then moving on to some of the tricky ones.

Mark: Um, make sure you know the person's name. It's always a big thing to know the person's name. And just be a bit patient.

Dr Melissa Kang: So it's really important not to rush. The goal is not to get through HEEADSSS and write to the three esses straightaway. What you're actually trying to do is engage this young person, and you have to remind yourself that the reason you want to engage the young person is it's the best way to do a health assessment, you're not going to do that if you rush through. So in order to get there, we actually need lots of information.

Dr Jane Ho: When I think about moving from asking more generalised to more personal questions, I think it's an easy to talk to the young person again to say.. I always go through, you know, some questions that I ask young people, and some of them are a bit more sensitive than others or some of them a bit more personal.

Doctor: Do you mind if I ask some more personal questions? And things like drugs and sex? Alcohol?

Young person: Yeah, I suppose.

Doctor: Look, it's a little bit awkward but I like to ask everybody, and you know, feel free that you don't have to answer anything if you're not comfortable with it, alright?

Young person: OK

Andre Zeballos: So some of the things I might say when I'm moving sort of to the more broad questions to the more personal questions like alcohol and other drugs or sexuality, say, for example with sexuality, getting permission from the young person - "Is it alright if I ask you about your sexual health? I know this can be a bit uncomfortable." So, acknowledging that there might be a bit of, you know, awkwardness in the room.

Doctor: Now, Sarah, I'm going to ask a few more personal questions now, this time I'm interested in talking about relationships and romance and sex, that kind of thing. So young people around your age are becoming interested in relationships and some might be having sex. Do you know whether any kids in your year are dating yet?

Young person: Um, yeah, some of them.

Doctor: Yeah and what about amongst your group of friends?

Young people: A couple.

Doctor: Yeah. And how about for you?

Young person: Yeah.

Doctor: Yeah?

Young person: Yeah.

Doctor: OK, tell me about that.

Young person: Um, I have a boyfriend.

Doctor: Oh, do you? OK.

Young person: Yeah.

Doctor: And how long have you been seeing him?

Young person: Couple of weeks.

Doctor: Just a couple of weeks?

Young person: Yeah.

Doctor: How's that going?

Young person: It's pretty good.

Doctor: Yeah? Is that pretty close, or...?

Young person: Yeah, but, like, not sex or anything.

Doctor: Not having sex yet?

Young person: No.

Doctor: Not thinking about that?

Young person: No.

Kate Tolley: Wait for them to reply. Sometimes it's tempting to just roll in, but I'd wait for them to say, "Yes, that's fine." Then, depending on age, for younger teenagers I might say something like, "Have any of your friends started being in relationships yet?" If they're a bit older, I'd probably be a bit more direct, you know, "Are you in a relationship?"

Andre Zeballos: Letting them know about confidentiality. I think...I can't stress that enough that the young person knows that information they're going to share with you isn't going to go elsewhere. I think that's really important, kind of making it a bit easier to have those conversations. With alcohol and other drugs, again, I might start with something more global, say, "Young people your age are experimenting." You know, "Have you ever seen that your friends are using alcohol and other drugs? How do you feel about that?" Allowing the young person some time to talk and then narrowing it down.

Healthcare worker: So we've talked a little bit about alcohol. Is it OK if we talk a little bit about drugs now?

Young person: Yeah, sure.

Healthcare worker: OK, great. Have you or your friends ever tried any drugs before?

Young person: Yeah, I've smoked pot a few times.

Healthcare worker: OK.

Andre Zeballos: You know, "Do you use drugs and alcohol yourself?" I find that this can be the one where young people might clam down a little bit, around alcohol and drugs, only because they're used to sort of facing the judgement of their parents or authority figures around that. Another thing I might say is, "Look, I'm not here to judge you. You know, I'm just gathering information. So, if you're telling me stuff around your drug use, you know, we're not here to kind of make you feel bad about that".

Dr Melissa Kang: What goes through my mind if a young person suddenly clams up is that, "OK, they're not engaged at this point in time. Maybe they don't trust me yet. Maybe they're not ready to talk about what it is I've just asked them. Or maybe they just don't actually think it's relevant. And that's OK."

Jacqui: I've always... I've always walked around having a wall up. You know, I've never...it's like I can't even build a window. You know, and probably a lot of other young people are like that. Yeah, my wall is always up, you know? And it's always...like, I've always been that person who's been by themselves.

Dr Jane Ho: I think that apart from respecting their desire not to talk, I think it's also important to give them time.

Healthcare worker: Do you ever drink alone or just by yourself at home?

Young person: Yeah, sometimes.

Healthcare worker: OK, how often would you say that happens?

Young person: Um...don't know.

Healthcare worker: OK. Shall we come back to this topic maybe a little bit later?

Young person: Yeah, sure.

Healthcare worker: OK.

Dr Jane Ho: If they're still not really open to talk, and to to be a very accepting of it, to be non-judgmental, not to be angry and say, "OK, that's fine, but do you think you can come back, and you know, let's try to talk... let's try to have another chat again later." So to follow up. So that would be good.

Andre Zeballos: But over time, kind of, the young person will sort of learn to trust you and learn that you're approachable as a worker, and then actually start to open up around some of the issues.

Dr Melissa Kang: Yeah, look, I think it's important to be aware that some people do find sensitive topics hard, so ask yourself which ones are harder than others and why that might be. It can be good to talk to colleagues about it or to actually practise asking those questions until you feel more comfortable.

Andre Zeballos: For me, I will often mentally rehearse, maybe, some of the questions or some of the areas that I-particularly if I know the young person - that I'd like to focus in on and and ask with the young person. So, spending a bit of time, I guess, reflecting, you know, using the Youth Health Resource Kit to go through and find ways of asking the questions can be useful.

Kate Tolley: Well, what I really like to see is that the young person is talking more or at least as much as I am, so it is really a two-way communication, not just me delivering information or firing questions at somebody.

Andre Zeballos: There are times where you do need to kind of step in and say, "Look...", I guess to talk to the young person and educate them. But really I think the spirit of the HEEADSSS assessment is about kind of getting the young person to open up and talk rather than us coming in as the expert, instructing or talking at the young person. A lot of young people are quite sensitive to that as well, like, you know the way they deal with teachers and parents, and they experience that their whole life. They're kind of...they're always being talked at. So to have someone take the back seat and listen and actually reflect on the young person, I think we underestimate how powerful that can be.

Voice over: The next video is Developing a responsive management plan. It covers: Useful management plan strategies; Exploring support options; and Managing; uncertain situations.

Developing a responsive management plan

Dr Melissa Kang: So when you've finished your assessment, it's important to come up with a management plan and work with the young person, and, when it's appropriate, maybe their parents or carers as well. And that's a really important part of shared decision-making.

Voice over: Developing a responsive management plan.

Dr Jane Ho: It's good to quickly summarize the points that you've covered in the conversation and then to have some sort of action or plan following.

Dr Melissa Kang: Because you're actively engaging with the young person in helping them identify, what they want to work on, helping them make decisions about what's going to work for them, then they're actually an active partner in their management plan, and that means that they're more likely to stick to it.

Doctor: What other things could you do to help yourself feel better?

Young person: I used to go for runs. I haven't thinking about doing that again. Because it didn't relieve my stress. I haven't, since everything that has been happening, so that maybe could be something I could start again.

Doctor: Great idea

Young person: OK.

Dr Melissa Kang: So if a young person says, "No, look, I'm really not worried about this," and yet it's something that I feel a little bit concerned about, then what I do is give them some information, because perhaps they're not really fully aware of some of the consequences of certain by health risk behaviors. So I own those concerns. I might say to a young person, "These are the things I'm worried about - X, Y, Z."

Healthcare worker: Paul, I've got a few worries about some of the things you told me earlier about drinking. I was wondering if we could talk about that a little bit more?

Young person: Yes, sure.

Healthcare worker: OK, great. And I know you said at the moment you're not really thinking about making any changes, but I was just wondering if I could leave you a few things to have a look over, and I can come back tomorrow and we can talk a little bit more about it.

Young person: Yeah. Yeah, sure.

Dr Melissa Kang: Now, I need to accept that that might not be the same as their concerns, but I can point out to them the facts around the health risks associated with certain behaviors or if they don't comply with certain treatment, just point that out to them without judging them. And then it's up to them to take that forward. And sometimes motivational interviewing techniques can be really useful in that situation.

Jacqui: I think the best thing for me personnally was, actually, letting me figure it out for myself. You're giving me that option to say, "Right, this is what you can do. These are the consequences. If you want to take it, just be aware of them," you know? And I can sit there and go, You know what? At the end of the day, I can go home and go, "Right, if I want to do that, am, I'm ready to face that consequence."

Dr Melissa Kang: So when I'm talking to a young person about a management plan, it's about, "Well, what do they want to do about this? What are the things that are important or priorities for them?" And then we look at what the supports are or what resources are out there that we need to take this forward.

Dr Jane Ho: I explore support options with the young person by actually asking them how they want, you know, help to be given to them, or what ideas do they have to help themselves. Having said that, it's not completely freeform, and you know, if they're struggling, then I have a structure in my head about, you know, easy tips and things and I suggest that as an option for them and then I ask how they could incorporate it into their lives.

Doctor: I think that you're not taking that medicine regularly is part of the reason why you've been feeling so low lately. So that really concerns me.

Young person: OK.

Doctor: And I think that you can do a lot to feel better for yourself if you start taking this medicine regularly and every day. What do you think?

Young person: I...I have been slack. I haven't taken it as much as I should.

Doctor: Look, so many things get in the way and that's it's not your fault or anybody's fault at all. It's just life, isn't it? Young people: Yeah.

Doctor: So what happens...Tell me more about how you take it. When do you do it?

Young person: I am supposed to take it in the morning.

Doctor: OK. Alright. And is it chaos in the morning?

Young person: Yeah, it is. Because I wake up late and then I have to catch the bus.

Doctor: OK

Dr Melissa Kang: So there are probably gonna be some times when you're really not sure what to do. If my concerns are about engagement, then I will check with the young person, you know, ask them if they'd like to come back and see me again, just state what my concerns are. If it's about perhaps a legal or an ethical issue, and I am really not sure about that, then I think it's important to talk to a more senior colleague or a couple of peers and just get some advice.

Andre Zeballos: You can actually work with the young people, model some of that health seeking behaviour. If you've got a computer nearby, you might be, "OK, I'm just gonna have a look at, you know, some mental health services that might be appropriate for you. Do you want to come and hop on Google and have a look and see if we can find it?"

Prof Kate Steinbeck: Sometimes you can't give a young person an answer straightaway. So I think you're honest and upfront and say "I really can't tell you that because I don't know, but I do know how to find out."

Healthcare worker: One of the staff members here actually has a lot of experience in that area. I might go and have a chat to her and come back with some information. Is that OK with you?

Young person: Yeah, it should be fine.

Healthcare worker: OK, great.

Dr Melissa Kang: When I'm wrapping up with a young person, it's really important to talk to the young person before bringing the parent into the room.

Doctor: OK, Sarah, well, thank you very much for talking to me and sharing everything with me. We're gonna wrap up now and I'm gonna invite mum to come into the room so that we can discuss anything that, you know, you'd like me to. There are two things that stood up for me that I would like to talk about with mum, one is the bullying that's been happening at school. I'm a bit worried that that's affecting how you're feeling and making you pretty...pretty sad. And I'd like to do something about that before it gets any worse. And I just think that maybe we should let mum know about that. And the other, of course, is around your relationship. Are you comfortable with us talking to mum about either of those things?

Young person: Just about the bullying. She doesn't know about my boyfriend yet, so...

Doctor: Oh, OK, so you'd prefer that we don't mention that?

Young person: Yeah. Not yeah.

Doctor: Well, look, that's fine. I can keep that confidential. Not a problem. But we will talk to her about the bullying and let her know that it's kind of upsetting you, OK.

Dr Melissa Kang: So I check out with them. Well, what do they want me to not share with their parents; What can I share with their parents. I don't disclose anything the young person has explicitly said they didn't want me to, within, of course the limits around confidentiality.

Doctor: So, Robyn, I just wanted to bring you back in now so that we could wrap up.

Dr Melissa Kang: It's really important to document your HEEADSSS conversation, and that's so that you can continue the conversation next time, or just to have it there as a baseline source of information and so that you can track progress or change over time.

Prof Kate Steinbeck: I think for every clinician, sometimes they feel they've missed an opportunity, that things were left unsaid, they didn't really get to the bottom of what the young person was...was needing them to ask. I think it's OK to say that and to ask if they'd like another opportunity to talk or an opportunity to talk to somebody else. I think it's important to trust your gut feelings too.

Dr Melissa Kang: There are times occasionally when I think, "Oh, I really missed an opportunity here." And usually that's when I've failed to engage that young person. It can happen sometimes with really young adolescents, just who a little bit more immature, less experienced at talking. But it can also be with their really vulnerable or disenfranchised young people who have a lot of trouble with trust anyway.

Andre Zeballos: After all my clients, you know, between the first time I've seen them and the next appointment, I'll always go through my mind and go, "OK. Was there areas that were brought up in the HEEADSSS assessment that maybe I didn't cover so well? Or maybe strengths that I didn't identify." As I'm writing the clinical notes, I'll be like, "Oh, I really didn't see that."

Kate Tolley: It's nice to reflect on the ones that go well. You know, what was it about that one that went so well? You know, was it the way I started it? Was it that I did kind of reinforce the privacy and they appreciated that?

Dr Melissa Kang: And I think that process of self-reflection in clinical practice is always important, and really good, then, to build your skills to keep on having really good HEEADSSS conversations with young people.


Current as at: Tuesday 19 November 2019