‘KEY CONCEPTS’ USED BY EUTEACH

Adolescent developmental process

Understanding adolescent development is a key precondition for managing any situation involving a teenager. This development proceeds at biological, cognitive, psychological and social levels and involves, amongst others, two main tasks - that of individuation and that of identity formation. By individuation, we mean the progressive acquisition of physical and emotional autonomy from parents and adults in general as well as the capacity for decision making. By identity formation we mean the development of stable concepts of self, including social, vocational and sexual roles.

Developmental stages
For practical purposes, adolescence can be divided in three main stages: early, middle and late adolescence. In every encounter, it is essential to tailor questions and information to the physical, cognitive and psychosocial developmental stage of the adolescent. Early adolescence (~10-13 years) is usually centred on body changes and is also characterized by poorly developed abstract thinking and a poor time perception. Middle adolescence (~14-16 years) is marked by intense involvement in peer relationships and increasing cognitive abilities. Late adolescence (~17-20 years) is characterized by further development of intimate relations, vocational planning and completion of abstract thinking along with the development of a realistic time perspective.

Rapid dynamic changes

As part of the acquisitions of new skills, the adolescent may fluctuate between different levels of functioning under different circumstances. Mood and behaviour can also change rapidly, which means that the assessment of most adolescents is best performed over a period of time.

Confidentiality, consent to diagnosis and treatment, privacy and ethical issues
The concept of confidentiality must be explained to the adolescent and confidentiality itself must be maintained for all adolescent encounters with notable exceptions depending on national laws (i.e. disclosure of sexual abuse, high-risk of self-harm including suicide, high risk of homicide, etc.). For ethical reasons, especially with a younger teenager, it might be acceptable to break confidentiality if it is in their best interest.

In most European countries, for issues concerning ‘consent to treatment’, adolescents are effectively entitled to the same rights as adults unless they are not considered fully ‘competent’ to understand the issues involved. To give fully informed consent, adolescents must be given developmentally appropriate information.

Physical and emotional privacy should be guaranteed in every health care setting.

Family centred approach
The process of individuation is not the achievement of complete independence so much as the redefinition of roles. The health professional should involve the family in an appropriate manner depending on the adolescent’s developmental stage and the health problem. Even when the parents are not physically involved in the treatment, professionals should investigate the previous and present roles of the parents in the young person’s life.

Interdisciplinary approach and networking

In many instances, the care of adolescents requires intervention by professionals from several different fields. The interdisciplinary approach is characterised by regular exchange of information, continuous cooperation, and delivery of coordinated information and intervention as well as keeping the patient informed of all these processes. This can be best achieved through meetings which involve all the different professionals involved. Key adults teachers, coaches, social workers - are often involved in the assessment and monitoring of difficult situations and should be connected (network) to the health care team.

Non judgmental and empathic approach

Many adults involved with the adolescent tend to succumb to the temptation of rating or judging his/her attitudes, behaviour and performance. The health care encounter represents a unique, and often extremely valuable initial occasion for the teenager to discuss his/her ideas and opinions as well as his/her lifestyles in a neutral and empathetic atmosphere. A non judgmental approach may have to be actively learned (e.g.via role playing techniques, supervision, etc.. In this respect, it is important for the adult to be age, gender and culture specific in their approach, that is to adapt the language and the approach to the individual’s characteristics and developmental stage.

History taking
This is the main process by which one obtains an adequate description of what the main problems and issues are, which brings the adolescent to the professional. It usually includes present complaints and problems, past medical history (including medical/health problems within the family) and a review of biopsychosocial situation. As far as adolescents are concerned, some aspects of history taking are particularly relevant e.g.

Focusing on resources and not only on problems, promotes the adolescent’s feeling as a individual responsible for his own health and well being and thus promotes the young person’s feelings of autonomy

Looking for a hidden agenda and masked symptoms: Many adolescents will not provide, in a straightforward way, the main reason for their visit as they may feel embarrassed to discuss personal matters such as sex affairs, substance used etc. Vague symptoms such as fatigue, faintness or pain must be assessed in a comprehensive way so to elicit potential burdens or psychosocial problems.