[0:00]heads isn't there to make us feel all hung up and and nervous and anxious. It's just a framework, it's just a guide to having a conversation. So try and think about it that way and it can be used very flexibly. Useful tips for heads conversations.
[0:19]So heads is the kind of conversation that you can actually have in any kind of setting, depending on what the situation is. So in a community setting when you've got a bit more time and you're actually there to do a health assessment, it really should be routine um that you start a head's conversation at some point in time. If it's an acute situation, like an emergency department or a busy hospital out patients, it might feel a bit harder to do that, but you can still find opportunities to start a head's conversation. I really like to get it going as soon as they're comfortable, um and you know they're not in pain or anything. And the reason being I think in hospitals more and more we see quite a rapid turnover. We don't want to leave it till they're headed out the door to maybe pick up some potential worries or complications. The first thing is that it really is important to try and have a little bit of time alone with most young people. And there are different ways to to do that. So I like to set it up before I even see them for the first time, so when they ring up and make an appointment, it's explained to the parent perhaps over the phone that the doctor will spend some time alone with the young person. But if the parent comes into the room, which often happens, into the consultation room, then I'll set that up at the beginning and I'll explain a couple of things. One is that I always see young people by themselves for some of the time and so I normalize that behavior. Okay, so what I'd like to do now, Robin, is spend a little bit of time alone with Sarah. I do this with all the young people that I see once they've reached about high school onwards. I spend a few minutes of the consultation by ourselves, just giving them an opportunity to chat with me. I think it helps young people learn to communicate with health professionals, learn to take responsibility for their health. But what I'd like to do is I'll bring you back in at the end so we can uh wrap things up. Would that be okay with both of you? Yeah. That's all right with you? Yep. Okay. Good. Thank you. And then again extending it to the young person, just saying oh you know what would you like, would you like your mum to sit in with you? Um if not, we're happy to have a conversation one on one, you might find it's a bit more comfortable if you're wanting to talk about more sensitive issues. So when I kick off a head's conversation I always introduce it, just a bit of a preamble with the young person. So, Sarah, what we're going to do today is have a bit of a chat. I'm going to ask you a few questions about anything that's worrying you about your health. But before I do that, I'd just like to explain confidentiality to you. What I mean by that is that anything you tell me is just between you and me. Um I can't tell anyone else, I can't go and tell mum, ok? without your permission. But there are a couple of exceptions to that, and one is if I'm really worried that you're about to go out and seriously hurt yourself or somebody else, or if someone else is hurting you, then I have a duty to keep you safe, and that might mean that I have to involve other people. Is that ok? Yeah, that's fine. Ask open ended questions, so let the young person talk about whatever it is that is concerning or of interest to them, rather than me having a fixed idea of what I have to ask. And the other is to let them guide the questions that I ask to some extent, so the conversation is guided by how they respond, um and I go in that direction or another direction. So, really just to let that conversation flow according to them. I think what's the most important thing to be comfortable talking with adults is knowing that um you there's someone you can trust. Best way that you can earn a patient's trust is to get to know them a bit more personally knowing that, you know, just asking them the questions, how's your day, how's your weekend? Any plans in the future? I do think, you know, starting with some of the softer questions, um what are your hobbies and sports and interests? Uh and then moving on to some of the tricky ones. Um make sure you know the person's name. It's always a big thing to know the person's name. And just be a bit patient. So it's really important not to rush. The goal is not to get through heads and right to the 3s straight away. What you're actually trying to do is engage this young person. And you have to remind yourself that the reason you want to engage the young person is that's the best way to do a health assessment, and you're not going to do that if you rush through. So in order to get there, we actually need lots of information. When I think about moving from asking more generalized to more personal questions, um I think it's an uh easy to talk to the young person again to say, I always um go through, you know, some questions that I ask young people, and some of them are a bit more sensitive than others, and some of them a bit more personal. Do you mind if I ask some more personal questions? Um things like drugs and sex, alcohol. Yeah, I suppose. Look, it's a little bit awkward, but I like to ask everybody and, you know, feel free that you don't have to answer anything if you're not comfortable with it. Okay. Alright. So some of the things I might say when I'm moving sort of to the more broad questions, to the more personal questions, like alcohol and other drugs or sexuality. Um say for example with sexuality, getting permission from the young person, is it alright if I ask you about your sexual health? I know I know this can be a bit uncomfortable. So, acknowledging that there might be a bit of, you know, awkwardness in the room. Now, Sarah, I'm going to ask a few more personal questions now, this time interested in talking about relationships and romance and sex, that kind of thing. OK. So young people around your age are becoming interested in relationships and some might be having sex. Do you know whether any kids in your year are dating yet? Um yeah, some of them. Yeah, and and what about amongst your group of friends? A couple. Yeah. And and how about for you? Yeah. Yeah. Okay. Tell me about that. Um, I have a boyfriend. Oh, do you? Okay. Yeah. And how long have you been seeing him? couple of weeks. Just a couple of weeks? Yeah. How's that going? It's pretty good. Yeah. Is that pretty close or? Yeah, but like not sex or anything. Not having sex yet? No. Not thinking about that? No. Ok.
[6:17]Wait for them to reply. Um sometimes it's tempting to just roll in, but I'd wait for them to say, yes, that's fine. Then, depending on age, for younger teenagers, I might say something like, Have any of your friends started being in relationships yet? If they're a bit older, I'd probably be a bit more direct, you know, Are you in a relationship? Letting them know about confidentiality. I think I can't stress that enough, that the young person knows that the information they're going to share with you isn't going to go elsewhere. Um I think that's really important kind of making it a bit easier to have those conversations. With alcohol and other drugs, again, I might start with something more global, say more young people, your age or experimenting. Um, you know, have you ever seen that your friends are using alcohol and other drugs? How do you feel about that? Allowing the young person some time to talk and then narrowing it down. So we've talked a little bit about alcohol. Is it OK if we talk a little bit about drugs now? Yeah, sure. Okay, great. Have you or your friends ever tried any drugs before? Yeah, I've smoked pot a few times. Okay. You know, do you do you use drugs and alcohol yourself? I find that this can be the one where young people might clam down a little bit around alcohol and drugs, only because they're used to sort of facing the judgment of their parents or authority figures around that. Another thing I might say is, Look, I'm not here to judge you. Um, you know, I'm just gathering information. Um, so if you're telling me stuff around your drug use, you know, we're we're not here to kind of make you feel bad about that. What goes through my mind if a young person suddenly claims up is that ok, they're not engaged at this point in time. Maybe they don't trust me yet. Maybe they're not ready to talk about what it is I've just asked them. Or maybe they just don't actually think it's relevant, and that's okay. I've always I've always walked around having my wall up. You know, I've never it's like I can't even build a window. You know, and probably a lot of other young people are like that. You know, my wall's always up, you know, and it's it's always like, I've always been that person who's been by themselves. I think that apart from respecting their desire not to talk, I think it's also important to um give them time. Do you ever drink alone or just by yourself at home? Yeah, sometimes. Okay. How often would you say that happens? Um, don't know. Okay. Shall we come back to this topic maybe a little bit later? Oh yeah, sure. Okay. If they're still not really open to talk, um to to be very accepting of it, to be non-judgmental, not to be angry, and say, OK, that's, that's fine. But do you think you can come back and um let's, you know, let's try to talk to it uh, you know, let's try to have another chat again later. So to to follow up. Um Uh, so that would be good. But over time kind of the young person will sort of learn to trust you and learn that you're approachable as a worker. Um and then actually start to um open up around some of the issues. Yeah, look, I think it's important to be aware that some people do find sensitive topics hard, so ask yourself which ones are harder than others and why that might be. It can be good to talk to colleagues about it or to actually practice asking those questions until you feel more comfortable. For me, I will often mentally rehearse, maybe some of the questions or some of the areas that I, particularly if I know the young person, that I'd like to focus in on and and ask uh with a young person. So, so spending a bit of time, I guess reflecting, um, you know, using the youth health resource kit to go through and and find ways of asking the questions can be useful. But what I really like to to see, um, is that the young person is is talking more or at least as much as I am, so it is really a two-way communication, not just me delivering information or firing questions at somebody. There are times where you do need to kind of step in and and say, look, I guess to talk to the young person and educate them. Um but really I think the spirit of the the head assessment is about kind of getting the young person to open up and talk, um rather than us coming in as the expert, um instructing or talking at the young person. Um a lot of young people are quite sensitive to that as well, like, you know, the way they deal with teachers and parents, and they experience that whole life they kind of they're always being talked at. Um so to have someone take the back seat and listen and actually reflect on the young person. I think we underestimate how powerful that can be. The next video is developing a responsive management plan. It covers useful management plan strategies, exploring support options, and managing uncertain situations.
