A structured psychosocial history, covering home, education, activities, drugs, sexuality, suicide and safety, finds problems that a presenting complaint does not. It takes a few minutes and works best with the parent out of the room for part of it.
Explain confidentiality and its limits first, and start with the less sensitive areas.
- See adolescents alone for part of every consultation after explaining confidentiality.
- Work from less to more sensitive topics: home and school before drugs, sex and mood.
- Include online life and sleep in the activities questions.
- Record what was covered so the next clinician can pick up from there.
Why it matters
The reason a teenager comes in is rarely the most important thing going on.
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