Dr Melissa Kang: HEEADSSS isn't there to make us feel all
hung up and nervous and anxious. It's
just a framework. it's just a guide to
having a conversation. So try and think
about it that way. And it can be used
very flexibly. Voice over: Useful tips for HEEADSSS
conversations. Dr Melissa Kang: So HEEADSSS is the kind of
conversation that you can actually have
in any kind of setting depending on what
the situation is. So in a community
setting, when you've got a bit more time
and you're actually there to do a health
assessment, it really should be routine
that you start a HEEADSSS conversation at
some point in time. If it's an acute
situation, like an emergency department
or a busy hospital outpatients, it might
feel a bit harder to do that, but you can
still find opportunities to start a
HEEADSSS conversation. Kate Tolley: I really like to get
it going as soon as they're comfortable
and you know they're not in pain or
anything. And the reason being, I think in
hospitals more and more we see quite a
rapid turnover. We don't want to leave it
til they're headed out the door to maybe
pick up some potential worries or
complications. Dr Melissa Kang: The first thing is that it
really is important to try and have a
little bit of time alone with most young
people. And there are different ways to
do that. So I like to set it up before I
even see them for the first time, so when
they ring up and make an appointment
it's explained to the parent perhaps,
over the phone that the doctor will
spend some time alone with the young
person. But if the parent comes into the
room, which often happens, into the
consultation room, then I'll set that up
at the beginning and I'll explain a
couple of things. One is that I always
see young people by themselves for some
of the time, and so I normalise that
behavior. Doctor: OK, so what I'd like to do now
Robyn, is spend a little bit of time
alone with Sarah. I do this with all the
young people that I see once they've
reached about highschool onwards. I spend
a few minutes of the consultation by
ourselves, just giving them an
opportunity to chat with me. I think it
helps young people learn to communicate
with health professionals, learn to take
responsibility for their health. But what
I'd like to do is I'll bring you back in
at the end that we can wrap things up.
Would that be okay with both of you? Young person and mum: Yeah
Mum: That's alright with you? Young person: Yep. Mum: OK.
Doctor: Good, thank you. Mum: Sure. Andre Zeballos: And then again, extending it to
the young person, just saying, "Oh,
What would you like? Would you like your
mum to sit in with you? If not,
we're happy to have a conversation
one on one. You might find it's a bit
more comfortable if you're wanting to
talk about more sensitive issues". Dr Melissa Kang: So when
I kick off a HEEADSSS conversation, I always
introduce it, just a little bit of a
preamble with the young person. Doctor: So, Sarah,
what we're going to do today is have a
bit of a chat. I'm going to ask you a few
questions about anything that's worrying
you about your health. But before I do
that, I'd just like to explain
confidentiality to you. What I mean by
that is that anything you tell me is
just between you and me. I can't tell
anyone else, I can't go and tell mum, OK,
without your permission. But there are a
couple of exceptions to that, and one is
if I'm really worried that you're about
to go out and seriously hurt yourself or
somebody else, or if someone else is
hurting you, then I have a duty to keep
you safe and that might mean that I have
to involve other people. Is that oK? Young person: Yeah, that's fine.
Dr Melissa Kang: Ask open-ended questions, so let the
young person talk about whatever it is
that is concerning or of interest to
them, rather than me having a fixed idea
of what I have to ask. And the other is
to let them guide the questions that I
ask to some extent, so their conversation
is guided by how they respond, and I go
in that direction or another direction.
So, really just to let that conversation
flow according to them. Mark: I think what's
the most important thing to be
comfortable talking with a doctor is
knowing that there's someone you can
trust. The best way that you can earn a
patient's trust is to get to know them a
bit more personally, knowing that... you
know, it's asking the questions "How's
your day? How's your weekend? Any plans in
the future?" Andre Zeballos: I do think, you know, starting
with some of the softer questions - "What
are your hobbies and sports and
interests?" And then moving on to some of
the tricky ones. Mark: Um, make sure you know the
person's name. It's always a big thing to
know the person's name. And just be a bit
patient. Dr Melissa Kang: So it's really important not to
rush. The goal is not to get through
HEEADSSS and write to the three esses
straightaway. What you're actually trying
to do is engage this young person, and
you have to remind yourself that the
reason you want to engage the young
person is
it's the best way to do a health
assessment, you're not going to do that
if you rush through. So in order to get
there, we actually need lots of
information. Dr Jane Ho: When I think about moving
from asking more generalised to more
personal questions, I think it's an easy
to talk to the young person again to say..
I always go through, you know, some
questions that I ask young people, and
some of them are a bit more sensitive
than others or some of them a bit more
personal. Doctor: Do you mind if I ask some more
personal questions? And things like drugs
and sex? Alcohol? Young person: Yeah, I suppose. Doctor: Look, it's
a little bit awkward but I like to ask
everybody, and you know, feel free
that you don't have to answer anything
if you're not comfortable with it, alright? Young person: OK
Andre Zeballos: So some of the things I might say when
I'm moving sort of to the more broad
questions to the more personal questions
like alcohol and other drugs or
sexuality, say, for example with sexuality,
getting permission from the young person -
"Is it alright if I ask you about your
sexual health? I know this can be
a bit uncomfortable." So, acknowledging
that there might be a bit of, you know,
awkwardness in the room. Doctor: Now, Sarah, I'm going to
ask a few more personal questions now,
this time I'm interested in talking about
relationships and romance and sex, that
kind of thing. So young people around
your age are becoming interested in
relationships and some might be having
sex. Do you know whether any kids in your
year are dating yet? Young person: Um, yeah, some of them. Doctor: Yeah
and what about amongst your group of
friends? Young people: A couple. Doctor: Yeah. And how about
for you? Young person: Yeah. Doctor: Yeah? Young person: Yeah. Doctor: OK, tell me
about that. Young person: Um, I have a boyfriend. Doctor: Oh, do you? OK. Young person: Yeah. Doctor: And how long have
you been seeing him? Young person: Couple of weeks. Doctor: Just a
couple of weeks? Young person: Yeah. Doctor: How's that going?
Young person: It's pretty good. Doctor: Yeah? Is that pretty
close, or...? Young person: Yeah, but, like, not sex or
anything. Doctor: Not having sex yet? Young person: No. Doctor: Not
thinking about that? Young person: No. Kate Tolley: Wait for them
to reply. Sometimes it's tempting to just
roll in, but I'd wait for them to say, "Yes,
that's fine." Then, depending on age, for
younger teenagers I might say something
like, "Have any of your friends started
being in relationships yet?" If they're a
bit older, I'd probably be a bit more
direct, you know, "Are you in a
relationship?" Andre Zeballos: Letting them know about
confidentiality. I think...I can't stress that
enough that the young person knows that
information they're going to share with
you isn't going to go elsewhere. I think
that's really important, kind of
making it a bit easier to have those
conversations. With alcohol and other
drugs, again, I might start with something more
global, say, "Young people your age
are experimenting." You know, "Have you
ever seen that your friends are using
alcohol and other drugs?
How do you feel about that?" Allowing the
young person some time to talk and then
narrowing it down. Healthcare worker: So we've talked a
little bit about alcohol. Is it OK if
we talk a little bit about drugs now?
Young person: Yeah, sure. Healthcare worker: OK, great.
Have you or your friends ever tried any
drugs before? Young person: Yeah, I've smoked pot a few times. Healthcare worker: OK.
Andre Zeballos: You know, "Do you use drugs and
alcohol yourself?" I find that this can be
the one where young people might clam
down a little bit, around alcohol and
drugs, only because they're used to sort
of facing the judgement of their parents
or authority figures around that. Another
thing I might say is, "Look, I'm not here
to judge you. You know, I'm just gathering
information. So, if you're telling me
stuff around your drug use, you know,
we're not here to kind of make you feel
bad about that". Dr Melissa Kang: What goes through my mind if a young
person suddenly clams up is that, "OK,
they're not engaged at this point in
time. Maybe they don't trust me yet. Maybe
they're not ready to talk about what it
is I've just asked them. Or maybe they
just don't actually think it's relevant.
And that's OK." Jacqui: I've always... I've always
walked around having a wall up. You know,
I've never...it's like I can't even build
a window. You know, and probably a lot of
other young people are like that. Yeah, my
wall is always up, you know? And
it's always...like, I've always been
that person who's been by themselves. Dr Jane Ho: I
think that apart from respecting their
desire not to talk, I think it's also
important to give them time. Healthcare worker: Do you ever
drink alone or just by yourself at home?
Young person: Yeah, sometimes. Healthcare worker: OK, how often would you
say that happens? Young person: Um...don't know. Healthcare worker: OK. Shall we
come back to this topic maybe a little
bit later? Young person: Yeah, sure.
Healthcare worker: OK. Dr Jane Ho: If they're still not really open to
talk, and to to be a very accepting of it,
to be non-judgmental, not to be angry and
say, "OK, that's fine,
but do you think you can come back, and
you know, let's try to talk...
let's try to have another chat
again later." So to follow up. So
that would be good.
Andre Zeballos: But over time, kind of, the young person
will sort of learn to trust you and
learn that you're approachable as a
worker, and then actually start to open
up around some of the issues. Dr Melissa Kang: Yeah, look, I
think it's important to be aware that
some people do find sensitive topics
hard, so ask yourself which ones are
harder than others and why that might be.
It can be good to talk to colleagues
about it or to actually practise asking
those questions until you feel more
comfortable. Andre Zeballos: For me, I will often mentally
rehearse, maybe, some of the questions or
some of the areas that I-particularly if
I know the young person - that I'd like to
focus in on and and ask with the young
person. So, spending a bit of time,
I guess, reflecting, you know, using the
Youth Health Resource Kit to go through
and find ways of asking the questions
can be useful. Kate Tolley: Well, what I really like to
see is that the young person is talking
more or at least as much as I am, so it
is really a two-way communication, not
just me delivering information or firing
questions at somebody. Andre Zeballos: There are times
where you do need to kind of step in and
say, "Look...", I guess to talk to the young
person and educate them. But really I think
the spirit of the HEEADSSS
assessment is about kind of getting the
young person to open up and talk rather
than us coming in as the expert,
instructing or talking at the young
person. A lot of young people are quite
sensitive to that as well, like, you know
the way they deal with teachers and
parents, and they experience that their
whole life. They're kind of...they're
always being talked at. So to have
someone take the back seat and listen
and actually reflect on the young person,
I think we underestimate how powerful
that can be. Voice over: The next video is Developing
a responsive management plan. It covers:
Useful management plan strategies;
Exploring support options; and Managing;
uncertain situations.