See also

• Mental state exam
• Sexual health history taking in the adolescent
• Sexually transmitted infections (STIs)
• Management of eating disorders in the emergency department

Key points

1. Adolescence is a transitional phase of growth and development between childhood and adulthood
2. Adolescents have the legal right to confidential care
3. Adolescents <18 years old may be considered 'mature minors', capable of giving informed consent
4. The HEEADSSS interview is a useful screening tool, that can also aid engagement. It is best completed with the adolescent alone

Background

• Adolescence spans from age 12 to young adults
• Adolescence approximates the phase between pubertal onset and legal 'independence', and generally corresponds with attendance at high school

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
• Be explicit about confidentiality and the requirements/limitations early in the consultation
  • obtain permission prior to contacting other relevant professionals, such as school or youth agencies

Confidentiality and consent

• Confidentiality is an ethical and legal right for the adolescent who is sufficiently competent to make his or her own medical decisions
• Competence is determined by clinical judgment of the adolescent's stage of development and their ability to understand what is being discussed, in the context of the relevant local or national legislation
• 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 or physical, emotional or sexual abuse)
    • Some disorders such as psychosis, may need special consideration about the risk of harm and therefore need to inform others
• 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 14-18 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 provide advice on who provides consent in what context

The HEEADSSS psychosocial interview for adolescents

The HEEADSSS interview is a useful screening tool that can

• Build rapport
• Identify risk and protective factors and the young person's competencies in order to look for opportunity to intervene earlier
• Identify healthy and maladaptive coping strategies and supports e.g. "Who can you talk to when you're feeling down?"

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

• "I'm going to ask you all about your life and some questions will be personal. Whatever you say will be kept private and between us, and not be passed on to your parents or anybody else outside this room, unless you give permission"
• "The only exception would be in a circumstance in which telling someone else is required by law"
  Or
• "If you tell me something that means there is a serious risk to your health, or someone else's, and because of this, I will need to get someone else involved in your care, like a parent or another doctor, I will tell you that. If you disagree, then together we can discuss the way to proceed"
  
  
• 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 vapes/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

** 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 (MSE) and admission, eg intentional overdose, see Poisoning — acute guidelines for initial management
• 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 and if eligible a concession card

Transition to adult services

• Transition to adult services should be considered from mid-adolescence and include formal support and education, aiming to transition to adult services by 18^th birthday or once 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 and/or social work may be the most appropriate teams 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: provides mental health services to 12-25 year olds and their families through headspace centres across Australia and via online and phone support services. Headspace can help young people with mental health, physical health (including sexual health), alcohol and other drug services, and 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 with support for young people
• Healthdirect: reliable Australian health advice

Referral for counselling / psychology services

• GPs can refer patients to psychologists under a Mental Health Plan (under the Better Access initiative) 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

13YARN: 13 92 76  (first national service of its kind for Aboriginal and Torres Strait Islander people in crisis. It offers a confidential one-on-one over the phone yarning opportunity and support with a trained Lifeline Aboriginal and Torres Strait Islander Crisis Supporter for mob who are feeling overwhelmed or having difficulty coping)

State-based 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 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. 

Playsafe: sexual health information, online help service 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

Mental Health Line: 1800 011 511

Queensland

Child and Youth Mental Health Services: specialise in helping infants, children and young people up to age 18 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

ADIS: 24-hour Alcohol and Drug Information Service for Queensland, for people with alcohol and other drug concerns. For help outside of hours, call 1800 177 833. Online resources

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

13 HEALTH: 13 43 25 84

South Australia

The Women's and Children's Health Network runs the specialised Child and Adolescent Mental Health Service (CAMHS) and the Youth Mental Health Service supports young people aged 16 to 24 years of age. Young people can access Youth Mental Health Services 24 hours a day, 7 days a week by calling 13 14 65

Metropolitan Youth Health: Aboriginal youth program

Metropolitan Youth Health: trauma-aware and trauma-responsive specialist health care provider

ShineSA: Sexual health and relationship wellbeing for all. Provides sexual health clinics, counselling and confidential nurse run sexual health phoneline

Service to Youth Council (SYC): Focuses on employment, training and youth services for people in need

Drug and alcohol services South Australia (DASSA): statewide health service that offers a range of prevention, treatment and information services for people with alcohol, tobacco and other drug issues

Victoria

Child & Adolescent Mental Health Services (CAMHS): Victorian government mental health services are region-based and include Orygen Specialist Program which provides specialist mental health services for young people aged 12-25

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

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

Sexual Health Victoria: 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 <18  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

Suicide HelpLine: 1300 651 251

Western Australia

Child and Adolescent Mental Health Services (CAMHS) provides recovery-focused programs and services for children from birth until 18 years. For urgent mental health help or advice for children and young people, call CAMHS Crisis Connect on 1800 048 636, 24 hours a day, 7 days a week

Youth Friendly Doctors: AMA WA youth friendly GP list

Get the Facts: Accessible information provided by WA Health about bodies, relationships, STIs, sex, keeping safe. Includes fact sheets, videos, 'find a service' function in WA, 'find free condoms' in WA and ask anonymous questions

Yarning quiet ways is a resource to help parents to yarn with young Aboriginal people about strong, safe and healthy relationships. Written and designed in consultation with Aboriginal parents and carers

Sexual Health Quarters

Could I have it? STI facts, testing, advice and clinic locations

Sexual Assault Resource Centre (SARC): a free service located in Perth providing crisis services to people who have experienced a recent sexual assault (rape) in the last two weeks and counselling for sexual assault / abuse experienced recently or in the past. Services are available for people of all sexualities and gender identities aged 13 years and above

Drug and Alcohol Youth Service: a free and confidential service located in East Perth which provides young people (12-21) and their families with access to a comprehensive range of alcohol and drug services

Drug and alcohol treatment services: provides treatment services for alcohol and other drug use, as well as support for families. Provides 24 hours a day 7 days a week counselling and referral service on 61 08 9442 5000 (1800 198 024 for country callers)

WA Youth Services Directory: direct contacts to help young people on their path through life. Directory for crisis support, youth-friendly doctors and live service tracker

Youth Futures: provide support and programs in areas of youth homelessness, education and support and wellbeing

Additional notes and resources

Decision Making by and for Individuals under the Age of 18

Confidential Health Care for Adolescents and Young People (12-24 years)

Youth friendly confidentiality resources

HEEADSSS Assessment learning video resource

Youth Health Risk Assessment

Orygen Youth Health factsheets

BeyondNow suicide safety plan app

NIMH Youth "Ask Suicide-Screening Questions" (ASQ) Toolkit & Youth Emergency Department Brief Suicide Safety Assessment Guide

Mood and Feelings Questionnaire (MFQ) by Duke University

eMHprac: e-mental health in practice: A guide to digital mental health resources

Last updated May 2025