response to colleague discussion

The health history interview is key in building the advanced practice clinician’s knowledge base by providing awareness of an individual health, habits, and risks. With that said, the stability of this key foundational information is only as solid as one’s ability to gather the information from the patient and their willingness to share. This weeks’ module has discussed strategies in communication tools/assessment tools that aid in efficient and thorough information gathering and rapport building.

This weeks’ scenario has me interviewing a 14-year-old biracial male living with his grandmother in a high-density public housing complex.The other scenarios include:

38-year-old Native American pregnant female living on a reservation Adolescent Hispanic/Latino boy living in a middle-class suburb

Pre-school-aged white female living in a rural community

How would your communication and interview techniques for building a health history differ with each patient?

38-year-old Native American pregnant female living on a reservation

 I would ensure a translator was available if needed. I would have a female colleague in the room as well if deemed favorable by the patient. I would ensure furniture arranged on equal planes and adequate spaced. I would ensure my body language was open and I would be active listening. I would que questions in open ended format and promote a sense of trust and compassion. “The topic of reproductive rights is particularly sensitive because of recent forced sterilization practices and should be remembered and respected by physicians when discussing family planning with AI/AN women”.(Cordova-Marks et al., 2020)

Pre-school-aged white female living in a rural community

This interview will be conducted with caretaker in the exam room. This interview would be geared toward gathering information of developmental progress as well as ensuring needs of care and safety are met by the caretaker. My questions toward the patient would be at their age level and using props if needed. This interview includes the caretaker as well, building rapport not only with the patient but the caretaker also.

Adolescent Hispanic/Latino boy living in a middle-class suburb

I would ensure a translator was available if needed. I would allow him to decide if he would like to interview independently of any caretaker. This would allow him a since of independence and trust. I would utilize open ended questions and relate to him on a personal level. I want to convey a since of understanding and non-bias answer to his questions/concerns.

(My Assigned Scenario)14-year-old biracial male living with his grandmother in a high-density public housing complex

I would allow him to decide if he would like to interview independently of any caretaker. I would arrange furniture ensuring all are the same level and adequately spaced. I would utilize open ended questions and begin by extracting interests. My attempts would be to gain trust and provide a sense of understanding through active listening and questioning. I would relate to the patient and discuss topics in his/her level of understanding and jargon. 

How might you target your questions for building a health history based on the patient’s social determinants of health? (14-year-old biracial male living with his grandmother in a high-density public housing complex)

I would first assess the current health of the patient upon initial meeting. This would gauge the direction of my questioning regarding social determinants of health. I would strive to build a trusting relationship prior to engaging in such. I would also prefer to converse privately. “It is important to make clear to both parent and patient that seeing the young person alone is routine and will allow them to start taking responsibility for their own health, increasing independence and encouraging them to freely speak about their worries and health concerns” (Doukrou & Segal, 2018). A screening tool available specifically for social determinants is the social needs screening tool by the American Academy of Family Physicians. “Screening and coordinating services to meet social needs is an opportunity to reduce physician and staff burnout related to the inertia of improving health in communities where social and policy barriers prevent us from doing so”(O’Gurek & Henke, 2018).

Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.

Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history

I decided to utilize the HEEADSSS risk assessment instrument to screen the assigned scenario of a 14-year-old biracial male living with his grandmother in a high-density public housing complex. The acronym HEEADDSSS is for: home, education/employment, eating, activities, drugs, sexuality, suicidal ideation, and safety. I strongly feel this screening tool would be useful for this scenario as it is broad, covering many factors. My concern would be pressured social influences with the potential of little adult supervision and opportunities to partake in risky behaviors. With that said, I would further my interview utilizing a CRAFFT tool focusing on alcohol and drug abuse.

The five targeted questions I identified as pertinent would be based from the CRAFFT tool which include:

C—Have you ever ridden in a Car driven by someone that was high or had been using drugs or alcohol?

R—Do you ever use alcohol or drugs to Relax, feel better about yourself?

A—Do you ever use drugs or alcohol when you are Alone?

F—Do you Forget things you did while using drugs or alcohol?

F—Do your Family and Friends ever tell you that you should cut down your drinking or drug usage?

T—Have you ever gotten into Trouble while using drugs or alcohol?

Two or more yes answers suggest high risk of a serious substance-use problem or a substance-use disorder.

(Doukrou & Segal, 2018)

In review, there are many useful screening tools for health screening of adolescents. This population is particularly vulnerable mentally and socially, requiring foresight and understanding to numerous variables. The interviewer must gain trust and foster an environment of safety, promoting a climate that fosters accurate information gathering. This population must understand the role of confidentiality and the need to notify persons if an unsafe situation is unveiled. “Empowering young people to take responsibility for their health will allow them to use the appropriate health services and lead healthier lives”(Doukrou & Segal, 2018). Adolescents health assessment would follow review of systems and SAMPLE (symptom, allergies, medication, past medical history, last po intake, events leading up to) as that of adult clients. However, we must ensure mental and socioeconomic risks are being evaluated and supported as needed.

Reference

Cordova-Marks, F., Fennimore, N., Bruegl, A., & Erdrich, J. (2020). What Should Physicians Consider About American Indian/Alaska Native Women’s Reproductive Freedom? AMA Journal of Ethics, 22(10), 845–850. https://doi.org/10.1001/amajethics.2020.845

Doukrou, M., & Segal, T. Y. (2018). Fifteen-minute consultation: Communicating with young people—how to use HEEADSSS, a psychosocial interview for adolescents. Archives of Disease in Childhood – Education and Practice, 103(1), 15–19. https://doi.org/10.1136/archdischild-2016-311553

O’Gurek, D. T., & Henke, C. (2018). A Practical Approach to Screening for Social Determinants of Health. Family Practice Management, 25(3), 7–12. https://www.aafp.org/fpm/2018/0500/p7.html

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