A school nurse conducts a confidential wellness visit with a 16-year-old using the HEEADSSS psychosocial assessment. Which risk-reduction actions are appropriate? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Explain confidentiality and its legal limits first to build trust (Choice 1). Provide private one-to-one time for sensitive topics rather than requiring a parent throughout (Choice 2). Proactively address STI prevention and contraception rather than waiting for the adolescent to ask (Choice 3). Counsel about tobacco, vaping, alcohol, and substances using motivational interviewing (Choice 4). Use validated depression and suicide screening with a safety plan and referral when indicated (Choice 5), and address seat belts, impaired driving or riding, and texting while driving (Choice 6).
Confidentiality Frame Open the visit with: "What we discuss is private, EXCEPT if I learn you are in danger of hurting yourself, hurting someone else, or someone is hurting you — those I must report."
Counseling Style - Motivational interviewing: open-ended questions, affirmations, reflection, summary - Strengths-based, non-judgmental - Provide brief anticipatory guidance even if no concern raised
Memory Tip "Confidentiality first; HEEADSSS; MI counseling; Screen depression/suicide"
ScenarioSchool nurse, 16 yo well visit, using HEEADSSS framework.
Visit Flow1. Open with confidentiality limits2. 1:1 time without parent for sensitive topics3. Risk-reduction counseling: seat belts, impaired/distracted driving, tobacco/vaping, alcohol/substance, sexuality/STI/contraception4. Depression/suicide screen (PHQ-9 modified) + safety plan5. Strengths-based MI6. Provide proactive guidance — do not wait for the teen to raise topics
Avoid- Requiring parent present for confidential topics- Deferring STI/contraception until client raises- Lecturing or shaming
HEEADSSS Adolescent Psychosocial Assessment — Validated framework for confidential 1:1 adolescent psychosocial assessment: Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety. Conducted privately without parent for sensitive items. Begins with explicit confidentiality framing including its limits (imminent self-harm, harm to others, abuse mandate reporting). Identifies risk and protective factors and guides anticipatory guidance.
Confidentiality in Adolescent Care — Adolescents have legal and ethical entitlement to confidential care for many sensitive issues (varies by state and topic — commonly STI testing/treatment, contraception, mental health, substance use). Required disclosures: imminent risk of self-harm, imminent harm to others, and child abuse. Nurses open visits by stating confidentiality and its limits, then dedicate 1:1 time without the parent. Forcing parental presence for sensitive topics is a barrier to disclosure and care.
Adolescent Mortality and Risk Counseling Priorities — Top adolescent mortality causes in the U.S.: unintentional injury (predominantly motor vehicle), suicide, and homicide. Anticipatory counseling priorities: consistent seat belt use, no impaired or distracted driving, helmet use, firearms safety; depression and suicide screening with validated tools and safety planning; tobacco, e-cigarette/vaping, alcohol, and other substance use using motivational interviewing; sexuality with STI prevention and contraception; healthy eating, activity, sleep. Nurses provide proactive guidance regardless of whether the adolescent raises the topic.