Taking the history of the young person's problems
As the health issues of young people are mostly sensitive in nature, it is good to start with the least sensitive or non-sensitive issues. For example, instead of asking at the start 'Are you sexually active?' which is very threatening to the young person, starting with 'Where do you live?', 'Do you go to school?' will help to open up the young person. Where possible, use the third person (indirect questions). It is good to ask first about friends' activities rather than directly about their own activities. For example, rather than ask a young person directly, 'Do you drink alcohol?' you could ask, 'Do any of your friends drink?' If the young person replies, 'Yes', you could then ask, 'Have you ever joined them?' This can lead to other questions, such as 'How often do you drink?', etc.
In addition to the presenting problems, the young people may have other health problems and concerns but may not say anything about them unless directly asked to do so. It is useful to go beyond the presenting problem and ask them if they have any other health problem. Consider using the HEADS assessment to help you do this.
HEADS is an acronym for:
The table below suggests issues you can raise and discuss with the young person using HEADS.
Information that can be obtained from the HEADS assessment
|Home||Where they live and with whom they live Whether there have been recent changes in their home situation How they perceive their home situation|
|Education or employment||Whether they study/work How they perceive how they are doing How they perceive their relations with their teachers and fellow students/employers and colleagues Whether there have been any recent changes in their situation|
|Eating||How many meals they have on a normal day What they eat at each meal What they think and feel about their bodies|
|Activity||What activities they are involved in outside study/work and what they do in their free time|
|Drugs||Whether they use substances like tobacco, alcohol, or others If they use any substances, how much do they use; when, where and with whom do they use them|
|Sexuality||Their knowledge about sexual and reproductive health Their knowledge about their menstrual periods and any questions and concerns that they have about their menstrual periods Their thoughts and feelings about their sexual behaviour Whether they are sexually active, and if so, the nature and context of their sexual activity Whether they are taking steps to avoid sexual and reproductive health problems Whether they have in fact encountered such problems (unwanted pregnancy, infection, sexual coercion), and if so, whether they have received any treatment for this|
|Safety||Whether they feel safe at home, in the community, in their place of study or work, on the road (as drivers and as pedestrians), etc. If they feel unsafe, what makes them feel so|
|Suicide/depression||Whether their sleep is adequate and whether they feel unduly tired How they feel emotionally Whether they have had any mental health problems (especially depression) and if so, whether they have received any treatment for this Whether they have had suicidal thoughts and whether they have attempted suicide|
You can use the points in the table mainly for those young people who come to your health facility for the first time. Depending on their context, you may need to adjust the points you discuss with them when they are not first-timers. Besides, you may not need to discuss all the points in the table if the young person is courageous enough to disclose their needs directly. In this case you can directly discuss their concerns. For example, if the young person tells you that they want you to give them condoms, you can now start discussing sexual behaviour instead of asking them about home, education, activity, etc.
Even if young people come to the health facility for health problems other than RH, you should assess them for sexual activity (whether they are at risk of STIs/HIV or pregnancy), substance abuse, and sexual abuse.