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Effective communication with adolescents and parents in the health care setting can be essential to the advancement of the adolescent’s health.

Potential challenges include:

  • Lack of adolescent experience in carrying out health-related conversations.

  • Lack of established trust, on the part of the adolescent and/or the parent, in the health care provider.

  • Tension between adolescent and parental interests.

  • Tension between the adolescent’s emerging autonomy and authority of the parents/guardians.

  • Tension between the adolescent’s desire to maintain privacy/autonomy and the adolescent’s simultaneous reliance on adults (and adult-controlled resources) to carry out life tasks, including those related to health care.

  • The possibility of discovering information (e.g., suicidal ideation reported trauma, abuse, neglect) that obligates the health care provider to act in a way that may disrupt the adolescent’s life or family unit, in pursuit of overriding goals such as adolescent safety.

Effective communication can be facilitated by “setting the stage” at the beginning of the encounter. This refers to establishing ground rules for the conversation and sets the expectation that you will speak with the parent and adolescent together, as well as the adolescent independently.

Setting the stage can help adolescents and parents to

  • Know what to expect from the encounter.

  • Develop trust in the health care team.

  • Be more at ease.

  • Avoid conflict.

  • Focus their interests on the adolescent’s health.

  • Avoid entering legal/ethical dilemmas unknowingly.

A conversation to set the stage should meet four key objectives. The adolescent needs to know

  • Why a health care provider will ask personal questions.

  • What the health care provider will do with the information.

  • What might be gained by sharing personal information with the health care provider.

  • Their rights to privacy/confidentiality and the limitations of privacy/confidentiality.

A step-by-step guide to setting the stage appears next.

Step-by-Step Guide to Setting the Stage

With the adolescent and the parent together

  • Begin the conversation with the adolescent and parent.

    • ✓ Make introductions and establish the purpose of the visit.

    • ✓ Explain that you will “set the stage.”

  • Establish roles.

    • ✓ Emphasize the adolescent’s participation in providing history.

    • ✓ Underscore the parent’s role as a resource and support.

  • Set the expectation for one-on-one communication with the adolescent

    • ✓ Frame this as routine practice.

    • ✓ This promotes adolescent development and creates opportunity for privacy.

    • ✓ It also creates an opportunity for a separate discussion with the parent(s).

With the adolescent and parent together or the adolescent alone

  • Explain why you will ask personal questions.

    • ✓ Frame this as routine practice.

    • ✓ Link this to your ability to fully address the adolescent’s issues(s) and give them opportunity for independence.

  • Privacy and the limitations of privacy

    • ✓ State that the adolescent’s information will be kept ...

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