“Hi, my name is Dr. Steph. Can you tell me why you have come to see me today?”
You never know what they are going to say, if anything at all. That is one of the joys of General Practice, the unpredictability. Particularly with adolescents. The ones that have been dragged in by their parent/carer, often reluctant to make eye contact, their whole body language reinforcing the message that they would rather be anywhere else than in the room with me. That is often how my appointments start.
However, ever so slowly, the young person can often be enticed to open up just by having a conversation about them; being interested, not judging them, and humour can smooth the way. This is where the Teen Health Talk comes in.
Let's have the Teen Health Talk
The Teen Health Talk is a communication tool that has been developed at the Well Centre, based on a pre-existing assessment tool called HEADSSS. The Well Centre is a young person’s health hub in Lambeth that has GPs, youth workers and a senior child and adolescent mental health services (CAMHS) practitioner co-located to provide a holistic approach to the health and wellbeing of young people age 11-20. The Teen Health Talk is used in all initial consultations with young people at the Well Centre, to help the clinician or youth worker identify and assess the needs and potential vulnerabilities of the young person with whom they are having the conversation. And all the while, the young person is often entirely unaware that they have having a biopsychosocial assessment, we we determine their biological, psychological, and social needs.
The Children & Young People’s Health Partnership (CYPHP) has supported the development of an abridged version of this for Primary Care, and with some additional contribution from the Health Innovation Network, the use of the resource has also been extended to youth workers.
Talking to Emily
Perhaps the best way to illustrate the use of the Teen Health Talk is by having an example. Emily, 16 years old, was dragged in by her mother. She was unhappy, having vicious arguments at home, interspersed with days spent withdrawn in her room. Her mother was worried that Emily was having sex and not using contraception. “Put her on the pill,” she demanded.
Emily continued to stare, head down facing the floor, while the conversation between her mother and I filled the air above her head. After some time, at last, I got the opportunity to ask to see Emily alone, and the Teen Health Talk started: Who else is at home with her and her mother? How do they get on? Is she at school or college - how is that going? What does she enjoy?
Slowly Emily raised her eyes from the floor and quietly became engaged in the conversation. I learned about what life is like at home and school for her. I heard about her worries about her father’s health, the clashes with her mother about her friends and boyfriend, her ambition to study law, but also the dark days of low mood, hopelessness, and self-harm. And that she wasn’t actually having sex at all and didn’t need contraception.
This was the first of many conversations that I went on to have with Emily over several years. She came to trust me and my colleagues. She further disclosed more about her anxiety and depression, and importantly was able to get the help and support that she needed. There were sad days of putting steri-strips on bleeding cuts on her arm, taking the boxes of hoarded paracetamol off her, and both of us wondering if she was ever going to get truly better. Gradually Emily began to have more good days than bad. The weekly visits became fortnightly, and then the intervals slightly longer, so we both dared to hope.
I will always remember the joy that we felt on the day that she came rushing in to see me. She had passed her A levels, got accepted into university, and the scars on her arms were fading to white. And she smilingly enquired if we could have that conversation about the pill…
I think it is clear that the years that make up adolescence are hard enough to navigate, even worse for those unlucky enough to experience mental health issues or long-term physical illness, and not infrequently both. The Teen Health Talk can support clinicians to open up those difficult, but important conversations with young people; conversations that we know young people want to have, but need help to find the words to say.
Dr. Stephanie Lamb
GP at the Well Centre, and GP and Young People Programme lead for the CYPHP.
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