Clinicians who provide primary health care to adolescents usually counsel the teens during their visits. While counseling should probably be a part of all visits with primary clinicians, training programs in adolescent medicine as well as national guidelines promote counseling services to teens.
In the early 1990s the American Medical Association with the assistance of authorities in the field of adolescent health care developed the Guidelines for Adolescent Preventive Services otherwise known as the GAPS recommendations. Consisting of 24 recommendations, GAPS recommended annual preventive health visits with a clinician for every adolescent; in addition, a significant amount of time during the visit should be devoted to counseling services. Some of the recommendations included the following:
- All adolescents should receive health guidance annually to promote a better understanding of their physical growth, psychosocial and psychosexual development and the importance of becoming actively involved in decisions regarding their health care.
- All adolescents should receive health guidance annually to promote the reduction of injuries.
- All adolescents should receive health guidance annually about the benefits of exercise and should be encouraged to engage in safe exercise on a regular basis.
Other recommendations include those on sexuality, substances, eating disorders and suicidal thoughts.
In placing these recommendations into practice, clinicians will determine areas where teens and their parents need counseling services. By Gathering, Assessing, Problem identification and Solution, the GAPS algorithm is utilized to help the teen. And this is often through counseling by the clinician.
For example, if a clinician determines by questioning at an annual visit, that a male teen is sexually active and not using condoms, counseling activities should follow. A clinician should not criticize nor judge the teen; rather, the clinician should address the risky activity. Counseling can include discussion of sexually transmitted illness and unwanted pregnancy. With this information, the teen should understand the consequences of his behavior not only for himself but also for his partner. As a result, he should intellectually understand why condom use is important. Then he needs to have access to condoms, know how to use them properly and have the social skills to use the condom at the appropriate time. Counseling may then include a demonstration of how to put on a condom using a model, discussion on where condoms are available at low or no barrier and how to work with his partner in using the condom properly at an appropriate time.
During their encounters with clinicians, teens may be counseled on a menu of topics which are determined in part by their stage in growth and development, age, cultural background and previous experiences. For example, teens early in the stages of growth and development may prefer more concrete counseling on height, weight and future growth potential. Teens around fifteen or sixteen years may require counseling on proper exercise and diet. Prior to college, teens may be offered counseling on alcohol or other substances.
Proper counseling does require the teen to feel that his or her conversations with the clinician are confidential. Many teens are unwilling to share sensitive information with a clinician if this information will be shared with parents. Parents should understand that confidentiality is a very important aspect of the encounter between a teen and his or her clinician.
Counseling may be performed for teens already involved in risky activities, and anticipatory guidance can be offered to teens during the times of change—which is most of adolescence. Anticipatory guidance may be given to girls before their first menstruation, or boys may be counseled on their impending growth spurt. Prior to college, anticipatory guidance is helpful in regard to issues around leaving home, sexuality, depression, academic workloads, time management and staying in touch with family. Other topics could include mental health, nutrition, substances and abuse.
Anticipatory guidance may also include teaching of coping strategies. These strategies could be as practical as a lesson on how to gracefully refuse an alcoholic beverage. Or if an unexpected event happens such as failure of an important test, the teen could be encouraged to do something physical in order to vent the feelings of frustration. If a teen has an ongoing problem with academic failure, then coping strategies could include efforts the teen could do to improve his or her grades.
Of course counseling should not be the exclusive service of a teen’s clinician. After all, the teen may only consult the clinician on an annual basis. Counseling should start in the family unit.
Some parents may find it difficult to counsel their teens, and others may feel quite comfortable with counseling. While it may be difficult to be objective with one’s adolescent child especially around sensitive issues such as sexuality, other topics may more amenable to counseling. Diet, exercise, use of seatbelts and bicycle helmets are matters that can be discussed at home. Many clinicians for adolescents also discuss these topics with their patients. Some parents purchase books and other sources of information and give these to the adolescent to read. Some adolescents prefer to read about these topics than hear about them from their parents! And in some families, a close aunt, uncle or cousin may offer very appropriate counseling.
Schools offer counseling services for their students. School nurses in some communities may provide information on contraception. Coaches, counselors and teachers may also provide counseling services that may be quite informal or formal in nature. And some schools have peer-counseling services where other students are available to discuss topics such as substance abuse.
Professional counseling services can be obtained for those teens that have the need for this type of service. A host of mental health clinicians including psychiatrists, psychologists, social workers, family therapists and nurse clinicians are some of the professionals who can counsel teens. A diagnosis of a mental disorder is certainly not required for visits with a therapist. For example, a teen may wish to consult one of these professionals during a family divorce or after the death of a loved one.
The teens who are most resilient, those who can adjust and react appropriately to stressors, or those who have the capacity to recover and adapt after an insult often have the most connectiveness. This connectiveness occurs in the family, friends, school and community. And along with this connectiveness is the capability to have appropriate counseling services should the need occur.
In 2006, physicians at the Massachusetts General Hospital Division of Adolescent Medicine and the Department of Psychiatry were developing a curriculum with the help of the Harvard Medical School Center on Mental Health and Media to teach physicians how to diagnose mental health disorders. It is the hope of this working group to educate primary care pediatricians on how to treat, include counsel, adolescents with mental health issues.
Related topics:
Academics, confidentiality, depression, divorce, growth and development, peer pressure, physical examinations, psychotherapy, risk-taking, separation anxiety, stress
