TLC FOR TROUBLED TEENS

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1 OUTREACH EDUCATION PEDIATRIC NURSING GRAND ROUNDS VIDEO-TELECONFERENCE SERIES TLC FOR TROUBLED TEENS... Program Handouts This information is provided as a courtesy by Children's Health Care System and its related organizations (CHCS). Persons accessing this information assume full responsibility for the use of the information and understand and agree that CHCS is not responsible or liable for any claim, loss or damage arising from the use of the information. The views and opinions of the document authors do not necessarily state or reflect those of CHCS. Neither the authors nor CHCS nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from the use of such information.

2 TLC for Troubled Teens How nurses can help heal those who seem unhelpable. Cora Collette Breuner, MD, MPH Seattle Children s University of Washington Tasks of Adolescence Achieve independence from parents Adopt peer codes and lifestyles Assign increased importance to body image and acceptance of one s own body image Establish sexual, ego, vocational and moral identities Assessment of Teens HEADSS: Home HEADSS assessment Establish confidentiality Legal rights of teens in the office Social structure evaluation Develop rapport with their physician Can be integrated into the review of systems or done at the end (we ask everyone) Where do you live? Who lives at home with you? Do you feel safe at home? Are their any weapons at home? Do your parents get along? Do you worry about their marriage? 1

3 HEADSS: Education HEADSS: Activities Where do you go to school? What grades do you get? Do you have an IEP? What is the best part about school/the worst part about school? What do you want to do after school is done? What do you do for fun? Do you have friends/a best friend? What do you do with your friends? Are you in any clubs, team sports, have a job? After school. HEADSS: Drugs Richardson JL Relationship between afterschool care of adolescents and substance use, risk taking, depressed mood and academic achievement. Pediatrics 1993 ;92 (1): th grade students; 32% white, 13% African American, 46% Hispanic, 9% Asian. Do any of your friends smoke/drink alcohol/smoke marijuana/do drugs? Have you ever tried? HEADSS: Sexuality HEADSS: Sexuality What kinds of friends do you have? Boys and girls? Do any of your friends date? Have you ever dated anyone/is there anyone that you like? Male, female or both? Are you dating someone now? How many boy/girlfriends have you had? Have you ever kissed someone? Have you ever touched someone/been touched? Have you ever had sexual intercourse? (sometimes you need to be specific) Have you ever been pregnant/gotten someone pregnant? Have you ever had an STD? 2

4 HEADSS: Suicide Have you ever felt sad? Have you ever felt depressed? What did you do about it? Have you ever felt like hurting yourself? Killing your self? Hurting someone else? Guidelines for Adolescent Preventative Services (GAPS) Forms 3

5 Case #1 Sandy is a 14 year old who is scheduled to see the health provider the next day for behavior problems. Mom wants to talk to the nurse before the appointment What should you do? It is the next day. Both parents have decided to come to the appointment. Mom pulls you aside before the appointment and wants to tell you that her daughter is hanging out with a fast crowd. How should you handle the appointment? The patient has told you that she is sexually active and wants to be placed on birth control. She begs you not to tell her parents who, incidentally, are right outside the door and are insisting on coming into the room. Now what? 80% of adolescents have had sex as teenagers, but most wait until middle or late adolescence Average age at first intercourse is for boys and for girls Case #2 Tom is a 16 year old who has had worsening school performance since he stopped his Ritalin. His teachers have requested that he be seen by your provider ASAP to talk about his medications. What do you need before you can schedule this patient? 4

6 Tom is in the office and is very angry about being there. He refuses to talk to you and just wants to flip through the Rolling Stone Magazine from your waiting room. How can you engage him in conversation? What are you concerned about? Tom has listened to you and is willing to share some of his concerns with you. He drinks every day after school. He does not want you to talk to his parents about this. Alcohol Alcohol 80-90% adolescents use by 18 years 3.4% college students use alcohol daily MVA under the influence leading cause of death in the year age group 30% of high school seniors report recent bouts of heavy drinking Alcohol use is involved in 40% of the 10,000 annual non-automotive teen deaths Alcohol Alcohol Screen % of 6th graders try it Binge drinking-5 or more consecutive drinks within the prior two weeks Binge drinkers are more likely to engage in unplanned sexual activity, 6 times as likely to drive intoxicated, and twice as likely to ride with an intoxicated driver CAGE-cut down, annoyed by comments, guilty, eye opener CRAFFT- Car, Relax, Alone, Forget, Family,Trouble Duggan AK et al. Detection of Alcoholism in Hospitalized Children and Their Families. AJDC. 145: ,

7 Case #3 Your next patient is a 17 year old who smokes a pack of cigarettes per day. She has reactive airway disease and is on three inhalers and requires frequent pulses of steroids. She was discharged last week from a PICU admit for a severe exacerbation. She also admits to being depressed. Usage Patterns: Nicotine Over 3,000 adolescents begin to smoke each day 41% between 12 and 17 years of age 11% high school seniors smoke > 10 cigs/day Scope of the Problem 50% of seniors who smoke more than a half a pack a day report that they cannot stop after trying 85% of those adolescents who smoke at least 2 cigarettes per day will go on to become regular smokers Most teens do not believe smoking is health hazard Depressive Disorders Population studies: Children--1 yr prevalence 2% Adolescents--1 yr prevalence 4% to 7% National Cormorbidity Survey-6.1%, yrs. Lifetime prevalence (up to age 18) of 15% to 20% among adolescents Anxiety Disorders Most common set of psychiatric disorders in children and adolescents with estimates of point prevalence in the range of 3-13% Case #4 14 year old white female with a history of 25 pound weight loss which began when she joined the neighborhood swim team. She was originally 135 pounds and was felt to be somewhat overweight at 5 1. She has been amenorrheic for 4 months. You see the patient alone and she is completely furious that her mother has brought her in. She states that her mother has told her over and over again that she needs to slim down a bit and now that she finally has, her mom is responding by bringing her in to the health practitioner. 6

8 Questions to ask: What is your maximum and minimum weight? What is your desired weight? Do you eat with your family? Are there any off limit foods? Any friends/family members with abnormal eating behavior? How much do you exercise? How do you feel if you can t exercise? Do you ever eat more than feels comfortable to you? What do you do if you do that? Tell me your eating routine on a typical day Last minute advice Respect Listen Reflect Advise Reassure Resources

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