CASE 1: How to Communicate with Teens/Eliciting HEADSSS
SELECTED CASES FOR DISCUSSION
CASE 1: How to communicate with teens/Eliciting HEADSSS
(Adapted from Case 2)
Ernesto, a 16 year old male, comes to your office, accompanied by his mother, to get a certificate of good health so that he may play basketball team. As his health provider, you know that he rarely comes to see you and you want to ensure that he is doing well physically, emotionally and is aware of behaviors which can be detrimental to his health and well-being.
Questions:
1. What are the issues that need to be addressed when dealing with this case?
2. What questions will you elicit using the HEADSSS format?
3. How will you encourage him to come for more regular health care visits?
CASE 2: Child Abuse/Molestation
(Adapted from Case 4)
Marina, age 13, is brought to your office by her mother who is concerned about her mood. Life has not been easy for the family these past few years. Marina’s mom has separated from her dad, who was an alcoholic and abusive to Marina and her two brothers. Her mom has found some happiness with a new partner, Tomas, who works days and so is able to help keep an eye on the children while Marina’s mother works the evening shift. The two younger boys go to bed early and Marina and Tomas often watch TV together in the evening. Marina discloses that Tomas has been touching her and she does not know what to do. She is so upset that she cannot concentrate at school, cannot eat, and cannot get her proper sleep and feels like killing herself.
Questions:
1. What are the issues that need to be addressed when dealing with this case?
2. How will you talk to your patient about these issues?
3. What laws (local and international) can apply in this case? What can you do to help the patient?
CASE 3: Rape
You are on call at your health center when you get a frantic call from your co-health worker. You learn that Linda, your 17 year old patient, has been brought to health center following a rape. She was out at an evacuation center with some girlfriends, and while going to the public comfort room, she decided to head home on her own. On her way home, she is attacked and gang raped by a group of boys.
1. Identify the issues that should be addressed in this case.
2. How will you go about reporting this case?
3. What are the resources or network in your community that can assist you address this issue?
4. How will you ensure the safety of this girl? Identify the role of the members of the community.
CASE 4: Exploring one’s sexuality/ Issue of virginity in a male
(Adapted from Case 8)
Gardo is 19 and still not sexually experienced. He has been raised in a strict family where sex was not discussed. He has taken a liking for Karina who has recently broken up with a fellow classmate. He knows that Karina and this classmate have been sexually active. He is afraid that she will think he is immature but he really doesn’t know much about this sex thing and he wants to look like a macho guy.
1. What are the issues that need to be addressed when dealing with this case?
2. How will you talk to this patient about the issues?
CASE 5: Violence and white slavery
(Asapted from Case 14)
Maria, who is 14, is brought to emergency beaten and bruised. She is from the province of Davao and wasbrought to Iloilo by her neighbor because she was told that she would get a job by manning the store of her contacts and make good money. When she got there, she found out that she was not going to work in a store, but was forced into prostitution. She was one of many girls who found themselves in the same predicament. They tried to protest but were given drugs repeatedly until they became submissive and did what they were told. They had no family or friends in Iloilo and were at the mercy of the pimp. Maria was working in the streets tonight and when she got into a car, the guy started verbally abusing her. She tried to get out of the car but he sped away and took her to the outskirts of town where he first had sex with her, then beat her and threw her out of the car. If it had not been for some sacada workers passing by, she would still be lying in the bush unconscious.
1. What issues are to be addressed in this case?
2. What medical concerns do you have to attend to in this case?
3. How will you go about reporting this case to authorities? What laws will help you in making your decision?
CASE 6: First sexual experience of a homosexual
Emilio is a 16 year old boy who was able to get a scholarship in a government university. He admits he is gay but has never had sex with anyone. Now, he lives in a boys’ dormitory just outside the school grounds. One night, one of his dorm mates knocks on his door and makes out with him, enticing him to engage in oral sex with the dorm mate of same age. Now he is very disturbed, confused, and guilty.
1. What are the issues that need to be addressed in this case?
2. How would you talk to the patient about these issues?
3. What can you do as a respected member of the community to address this issue?
CASE 7: Psychosomatic complaints PTSD
Bona, 18 years old, lost her parents and a younger brother during the Typhoon Yolanda. She now lives with her aunt’s family. Since last year, she has been having nightmares that awaken her. In the daytime, her aunt asks her to help in the laundry but she is sometimes not able to concentrate. She has lost some friends also during the typhoon. She finds herself crying. She has lately told her aunt that she cannot help because of backaches and headaches plus dizziness. Her aunt sees her staring blankly.
1.. What are the issues that need to be addressed in this case?
2. What resources are available in your community to make the proper referral?
CASE 8: Lesbianism – Coming Out
(Adapted from Case 19)
Girlie is 18 and comes to the health center not feeling well. Examination shows no physical problems but she seems anxious, unable to sleep well, and frequently daydreaming about her crushes. Upon further questioning, she tells you that she is afraid that she is gay. She is attracted to a female classmate in school. All her life, her family has made fun of gays and she has no one to talk to.
1. What are the issues that need to be addressed in this case?
2. How will you elicit the questions on her sexuality?
CASE9: Pregnancy in the offing
(Adapted from Case 9)
Sandra, age 16, comes in to see you regarding treatment for her acne, which is very minimal. You talk about the various topical treatments, but you see her hesitating. She finally gets up her nerve and tells you that her friend went to see her doctor about her acne and the doctor suggested she go on the birth control pill. You explore the situation delicately and find out that she has been having unprotected intercourse. Her last period was six weeks ago and her acne has gotten worse in the last two weeks. You suggest a pregnancy test, which you can do in your center, and it is positive. You talk about her options and she is not sure whether she should tell her parents. The boyfriend of just 6 months wants her to abort the baby. She is now very confused.
1. What are the issues that need to be addressed in this case?
2. How will you talk to the patient about these issues?
3. What are the community resources that can assist you address this issue?
Case 10: STI and suspicion of Pregnancy
Janet is a 17 year old female who recently transferred from the big city to live with her aunt and uncle. She has recently lost her immediate family members during the Typhoon Yolanda. There is not much to do in town. Schools have not started due to the recent disasters which have devastated the schools. Soon she is able to meet some older men who regularly drink local coconut wine and beer as past time in the afternoons till evening. She has had unprotected sexual activity with at least 3 guys in the group. She comes to you with vaginal discharge.
1. What are the issues that need to be addressed in this case?
2. How would you talk with your patient about these issues?
3. What might you, as a respected community member, do outside your office and in the community to deal with similar issues or to help prevent similar problems?
REFERENCE:
1. Training Manual for Adolescent Sexuality, Medical Women’s International Association, 2004