 Adolescents are more likely to access

health care, have a more favorable

attitude about their clinicians, and share
sensitive information when confidentiality
is assured. However, approximately 60%
do not get time alone with their clinician
for confidential discussion despite
patient and parental preferences.
 CONFIDENTIALITY
 Clinicians should regularly offer confidential screening
and counseling because when confidentiality is
assured, adolescents are more likely to access health
care, have a more favorable attitude about their
clinicians, and share sensitive information. However,
approximately 60% do not get time alone with their
clinician for confidential discussion despite patient
and parental preferences. Clinicians may request
privacy by asking, “As part of my routine practice,
may I take a moment to speak privately with your
daughter about possible stressors [or] to help her
begin to take responsibility for her health care?” and
clarify the approach to confidentiality.
 SSHADESS (strengths, school, home, activities, drugs,
emotions/eating, sexuality, safety) is a mnemonic to facilitate
collection of a psychosocial history of critical life
dimensions . Based on the traditional HEEADSSS (home,
education/employment, eating, activities, drugs, sexuality,
suicide/depression, safety) model, this approach emphasizes
identifying strengths within a youth's life experience while
assessing risks, which in isolation can provoke feelings of
shame. Prior examples of a patient overcoming adversity or
showing resilience can be incorporated into discussion using
praise and reflective interviewing. SSHADESS also prioritizes initial
queries about school functioning—which may be expected and
less personal than other topics—and broad screening for
emotions and stress rather than limited focus on depression. The
patient's history should be tailored to each patient's personal
context (including any adverse childhood or marginalization
experiences that may be disclosed as trust is built) instead of a
rigid checklist approach.
 SOCIAL MEDIA
 Clinicians should ask about media exposure
and educate families about digital literacy,
open family communication, and boundary
setting on content and display of personal
information.
 Recommendations for a family media use
plan
(www.healthychildren.org/MediaUsePlan),
lifestyle modifications, or behavioral health
consultation may help limit risk
 The American Academy of Pediatrics
recommends that clinicians screen
adolescents for substance use and, if
applicable, provide a brief intervention,
establish follow-up, and consider referral
(e.g., for weekly or more frequent use). The
CRAFFT+N (car, relax, alone, forget,
family/friends, trouble, nicotine) screening
tool is sensitive for identifying problematic
substance use (https://crafft.org/).32
 Adolescent pregnancy, a risk factor for adverse fetal and
maternal outcomes, has become less common in recent
years. According to a survey among adolescents 15 to 19
years of age, this trend was attributed to improvements in
contraceptive use as opposed to changes in rates of
sexual behaviors. Clinicians should counsel adolescents on
pregnancy risk, healthy relationships, and contraception,
including long-acting reversible contraception as a first-
line option and availability of emergency
contraception. Reducing barriers to contraceptives for
adolescents reduces health disparities and abortion rates
without increasing rates of sexual activity. Discussions
about menstruation and bleeding patterns should be
conducted regularly and may serve as a proxy for overall
health status.52
 For obesity prevention, clinicians may
recommend 60 minutes of moderate to
vigorous physical activity daily and
optimization of sleep habits; however,
exercise interventions alone may not
improve body mass index or health
outcomes. Clinicians may discuss healthy
eating patterns, including increased intake
of fruits and vegetables, plant-based fats
and proteins, legumes, whole grains, and
nuts, and avoidance of sweet beverages
and processed foods.58
 Eating disorders have high lifetime mortality
because of disease complications and risk
of suicide. If an eating disorder is
diagnosed, clinicians should recommend
evidence-based treatments (e.g., family-
based therapy) and arrange for
multidisciplinary care, including a therapist
and dietitian. Weight restoration is an initial
goal and may require inpatient admission.
 The U.S. Preventive Services Task Force recommends
that clinicians screen adolescents starting at age 12
and adults for major depressive disorder when
systems are in place to ensure accurate diagnosis,
treatment, and follow-up. The Patient Health
Questionnaire has been validated in adolescents .
Clinicians should interview individuals privately about
depressive symptoms and formulate individualized
plans if depression, self-harm, or suicidality is
identified. Self-injury among adolescents may be
related to poor coping skills and difficulty managing
emotions; the risk of subsequent suicide is
substantially higher among those who use violent
methods (e.g., a firearm) than with nonviolent
methods.
 The American Academy of Pediatrics
recommends that clinicians encourage
seatbelt use, adherence to graduated
driver's licensing laws (e.g., nighttime,
passenger restrictions), and avoidance
of distracted or impaired driving.
 Clinicians should inquire about patients' risk
of violence (e.g., history of abuse, gang
involvement, low school commitment, fear
of assault, use of weapons). Interventions
may focus on connecting adolescents with
positive adult role models, community
programs, and mental health services to
develop coping skills and healthy
relationships. Firearms should be stored
unloaded, locked, and separate from
ammunition.
 Reference: American Family
Physician. 2020 Feb 1;101(3):147-158.