See also

Adolescent gynaecology — lower abdominal pain
Adolescent gynaecology — heavy menstrual bleeding
Sexually transmitted infections (STIs)
Management of eating disorders in the emergency department
Mental state exam

Key points

1. Adolescence is a transitional phase of growth and development between childhood and adulthood 
2. Adolescents have the legal right to confidential health care
3. Adolescents less than 18 years old may be considered ‘mature minors’, capable of giving informed consent
4. The HEEADSSS interview for psychosocial screening is an important component of adolescent assessments
   

Background

What is adolescence?

• Historically spanning from ages 12–18 years, approximating the phase between pubertal onset and legal ‘independence’, and generally corresponding with attendance at high school 
• More recently the term has expanded to include young adulthood, up to 25 years of age
  

Adolescent health care considerations

• Increased risk-taking behaviours and psychosocial issues, contributing to morbidity and mortality
• Rarely access routine health care, so any contact should be an opportunity for preventative health care 
• Some health services manage those aged >16 years through adult services or on adult inpatient wards 
• Planning for transition to appropriate adult services should start well before age 18
  

Assessment

An adolescent consultation should include time with the adolescent and guardian/s together, as well as dedicated time with the adolescent alone

Confidentiality and consent

• Be explicit about confidentiality requirements and obtain permission prior to contacting other relevant professionals, such as school or youth agencies 
• Adolescents have the legal right to confidential health care unless:
  • they cannot be considered a mature minor and/or
  • there is significant concern regarding risk (ie harm to self or others, physical or sexual abuse)
    

• Mature minors can give informed consent if they have sufficient understanding and intelligence to enable full comprehension of what is proposed [as per Australian common law - Gillick competency]
  • Most adolescents aged 16–18 are presumed to be mature minors (legislation differs by State)
  • Younger adolescents may sometimes be considered mature minors and be capable of providing informed consent depending on the nature of the proposed intervention. Interventions include history, physical examination, procedures and treatments
    
• Adolescents involved with child protection services require special consideration with respect to confidentially and consent. The relevant State-based service may be able to assist when consent cannot be obtained in the usual way 

Psychosocial interview

The HEEADSSS interview is a useful screening tool, that can also aide engagement. It is best completed with the adolescent alone.

• Parents should be asked if they have any concerns prior to leaving the room and again at the close of the interview 
• Preface the interview by discussing confidentiality and explaining that you are about to ask lots of personal questions about the adolescent’s life, interests and behaviours, as these may be affecting their health and wellbeing 
• Try to use open-ended, non-judgmental questions that avoid assumptions
• General statements instead of personalising questions can be less intrusive (eg "some young people experiment with cigarettes, alcohol or drugs. In your year, do people smoke/drink/use illicit drugs? What about your friends? And you?")
• The HEEADSS framework is designed to progress from important but less threatening questions to those considered highly personal 
• It is often not possible to cover every aspect of the interview in a single encounter. You may focus on the most relevant areas for your patient or population 
• You may choose to end the psychosocial interview by asking the adolescent who they can trust and confide in if they have problems  

The HEEADSSS psychosocial interview for adolescents

** HEEADSSS screen may be adapted for local use

Examination

General considerations for physical examination of an adolescent patient:

• Use of a chaperone is recommended 
• Ensure privacy 
• For pubertal assessment (Tanner staging) consider asking the adolescent to make a self assessment

Management

General considerations

• Depends on the issues identified during psychosocial interview
• Adolescent health concerns can generally be viewed in terms of risk and protective factors 
• If there are significant health risk behaviours, devise an immediate management plan which may include formal mental health assessment and admission (eg intentional overdose, see Poisoning — acute guidelines for initial management) 
• Remember to document the adolescent’s contact details if follow-up is required
• Consider opportunistic vaccination

Medicare cards

• Anyone over the age of 15 years should be encouraged to obtain their own Medicare card

Transition to adult services

• Transition to adult services should be considered from mid-adolescence and include formal support and education 
• Most health services will aim to transition an adolescent to adult services by their 18^th birthday or once their final year of high school is completed
• For complex cases, a period of overlap between paediatric and adult services may be required to permit adequate communication between specialists and safe transition 
  

Consider consultation with local paediatric team when

Assessing any adolescent deemed to be at significant risk

Note: Depending on local resources and the adolescent’s presentation, mental health, adolescent medicine or social work may be the most appropriate team to consult 

For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services

Consider discharge when

• An assessment by mental health staff including a risk assessment has been completed, if indicated
• A clear discharge destination has been established, with follow-up and referrals to necessary services made

Parent information

• Adolescent transition – resources
• Raising Children – Teens (12–18 years)
  

Referral pathways and services

National services

Headspace: Centres act as a one-stop-shop for young people seeking help with mental health, physical health (including sexual health), alcohol and drugs issues, or work and study support

Youth beyond blue: Beyond blue’s youth program - provides online forums, the ‘check-in’ app, information and resources about mental illness in those aged 12–25 years 

Reachout: online resource that provides innovative e-mental health services directly to adolescents and young people 

Head to Health: Australian Department of Health site for access to digital mental health resources

Referral for counselling / psychology services:

• GPs can refer patients to psychologists under a Mental Health Plan (under the Better Access initiation) for up to 10 sessions per calendar year 
• Local psychologists can be found via the Australian Psychological Society’s ‘find a psychologist’ search function 
  

24-hour telephone help lines:

Kids Help Line                                                                                               1800 55 1800

Lifeline                                                                                                           13 11 14

Beyond blue                                                                                                  1300 224 636

Suicide Call Back Service                                                                            1300 659 467

Suicide HelpLine (VIC)                                                                                 1300 651 251 

Mental Health Line (NSW)                                                                            1800 011 511

13 HEALTH (QLD)                                                                                         13 43 25 84 

State-based services

Victoria

Child & Adolescent Mental Health Services (CAMHS): Victorian government mental health services are region-based

Eating Disorders Victoria: Support, information, community education and advocacy for people with eating disorders and their families in Victoria 

Melbourne Sexual Health Centre: Free, confidential, anonymous, sexual health service, fact sheets and national STI management guidelines

health.vic Sexual Health Services: resources and clinics across Victoria that provide sexual health services for LGBTI people

Action (Youth) Centre - (Family Planning Victoria): Free service and information for those under 18 years about sexual health issues, safe sex and support groups for those with gender identity issues 

YSAS (Youth Support and Advocacy Service): Outreach teams across Melbourne and regional Victoria for young people experiencing significant problems with alcohol and/or drug use 

YoDAA: Victoria’s Youth Drug and Alcohol Advice service - provides information and support for youth AOD needs or anyone concerned about a young person 

Young People's Health Service (FRONT YARD) : Free service, that focuses on the needs of the homeless or disadvantaged

Infoxchange Service Seeker: Search for local community support services e.g. local doctor, dentist, counselling services, drug and alcohol services 

New South Wales

Child and Adolescent Mental Health Services: services delivered across NSW Health with referrals made via the NSW Mental Health Line (1800 011 511) for 24-hour advice, assessment referral information 

Youth Health and Wellbeing: includes links to Assessment Guideline for providers caring for young people aged 12 – 24 years across settings, as well as links to other resources 

Sexual health Infolink: telephone referral line (1800 451 624, weekdays 9–5:30) staffed by specialist sexual health nurses, as well as internet-based information and referral service, providing access to all aspects of sexual health care. Specialises in HIV and STI risk assessment and treatment 

Playsafe: sexual health information, online help service and and links to appropriate medical centres 

Family planning NSW

Your room: information on alcohol and other drug use, including fact sheets (multiple languages), assessment tools and links to support services

Family and Community Services – support to find a home: homelessness service, including specific services for young people. Affiliated with Link2home, 24-hour information line (1800 152 152)

Health Services for Young People

Our Health Our Ways videos

Transition Care Network: improving delivery of healthcare for young people with chronic health problems and disabilities as they transition from paediatric to adult health services 

Queensland

Child and Youth Mental Health Services: specialise in helping infants, children and young people up to age 18 years with complex mental health needs

Youth Sexual health: information on sexual health checks, family planning, contraception and STI screening and treatment

Dovetail: provides clinical advice and professional support to workers, services and communities who engage with young people affected by alcohol and other drug use

Queensland Youth AOD Services Guide: created by Dovetail, this guide provides an overview of youth alcohol and other drug treatment services across Queensland. For help outside of hours, call the 24-hour Alcohol and Drug Information Service (ADIS) on 1800 177 833

Youth Housing and Accommodation

Brisbane Youth Service

Micah Projects: Support and advocacy services

Clarence St, Mater Young Adult Health Service: Youth drug and alcohol service

Additional notes and resources

Decision Making by and for Individuals under the Age of 18 

HEEADSSS Assessment learning video resource

Youth friendly confidentiality resources

Youth Health Risk Assessment

HEADSSS: get the conversation started (NSW only)

Queensland Health: Sexual health guidelines

Last Updated September 2019