Background
The World Health Organization defines
adolescent as 10–19 years, youth as 15–24 years and young people as 10–24
years.
Adolescent
developmental issues include physical and cognitive transitions, emergent
agency, autonomy and independence, personal identity and body image, peer
relationships, recreational/educational/vocational goals, and sexuality.
Adolescents of refugee-like background experience all these transitions in
addition to the transitions of resettlement. They face balancing the
values/expectations of their parents/cultural background with those of their
new peers, while developing their own identity and learning a new language, in
a new schooling system, in a new country.
Assessment
Please
see the adolescent health clinical practice guideline and the refugee health initial assessment. The following points are useful strategies for working
with adolescents who arrived as refugees or seeking asylum.
- Aim for physical and psychosocial
evaluation, with an emphasis on preventative care - healthcare visits may be limited, and adolescents may seek care from a
variety of providers.
- Adolescents should be seen alone at
some point during
(or soon after) the initial assessment. This may be more acceptable to parents and adolescents
if the health provider sees the family initially, and they are aware this will
occur in the future.
- Establish confidentiality for the medical consultation and (separately) for working with interpreters.
- Adolescents may have an incorrect date of
birth recorded - check this in the first visit, clarification
is important for consideration of growth, development, learning, and
school/vocational placement. See Birth date issues.
- Clarify access to education, prior schooling
experience (including language) and current pathways in Australia
- adolescents with interrupted schooling are usually better placed in the older
cohort within a classroom year (e.g. 13 yr old could be placed in year 7 where
there will be 12 and 13 yr old students). Evidence shows refugee young people
have similar education outcomes to their native-born peers - ensure a proactive
approach and early paediatric review for learning problems. See education assessment.
- It takes many years to learn English as an
additional language for academic purposes - explaining this is
important, and a way to explore schooling and risk/resilience factors.
- Mental
health problems may present in adolescence. Adolescents may make new
meaning from past trauma, and present with mental health concerns in relation
to early childhood trauma (see WHO fact sheet for useful summary and background, and Mental health).
- Sexual health is an important area that
is often neglected.
Many refugee-background young people have low sexual health literacy, and
limited opportunities to learn about sexual health. Consider sexually
transmitted infections (STIs, including hepatitis B), sexual violence, and
female circumcision.
- Family
structures and parenting roles may change with migration,
affecting settlement and leading to ‘role reversal’, with adolescents having
increased responsibility, or taking on parenting roles.
- Seek early paediatric review for
complex adolescent health issues,
including physical health, learning/behavioural concerns, disability, and age
assessment. Paediatric review may also help facilitate access to (and
acceptance of) mental health services.
- Unaccompanied or separated minors, and
adolescents (and children) on orphan relative visas should have specialist
paediatric assessment
- these cohorts have increased risk and vulnerability, and require long-term,
specialist care.
Screening
Please
see initial assessment for initial refugee health screening tests and catch-up
immunisation.
- Pre-arrival immigration medical screening for
adolescents includes urinalysis (5 years and older),
chest x-ray (11 years and older), HIV screening (15 years and older), and
syphilis screening (15 years and older). Unaccompanied minors (all ages) also
have screening for HIV and hepatitis B surface antigen (HBsAg); onshore protection visa applicants (15 years
and older) also have screening for HBsAg and hepatitis C virus (HCV).
- IGRA testing is more reliable in adolescents for
tuberculosis screening.
- Catch-up vaccination and vaccine licensing
varies with age. Adolescents will generally not need
pneumococcal or Hib vaccines, they will need human papillomavirus (HPV) vaccine, and the varicella
vaccine schedule changes at 14 years.
HEADSSS screening
HEADSSS
screening can be used to assess adolescent psychosocial health:
- H
– home
- E
– education/employment (and eating)
- A
– activities
- D
– drug and alcohol use
- S
– sexual activity
- S
– suicide, depression, self-harm
- S
– safety from injury and violence
Management
Resources
Resources are grouped alphabetically by topic area.
Alcohol and other drugs
Forced marriage
General
Legal and homelessness services
Mental health and trauma supports
Sexual health and pregnancy
Sports
- The Huddle: Sport and recreation, AFL Football
and study support programs
- Welcoming Australia - Sports - Sports and recreational programs promoting inclusion, opportunity and belonging - including for recent arrivals, refugees and people seeking asylum.
Immigrant health clinic resources: authors Georgie Paxton, Dan Mason and Karen Kiang, last update June 2020. Contact: georgia.paxton@rch.org.au.