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Communication is an essential component in providing health care for adolescent patients. A critical part of adolescence is identity development. Affirmation of identity and emphasis on individual strengths are important for this age group. The concept of resilience is at the center of adolescent care and shapes how care is defined and delivered. A primary goal is to protect patients from harm through a combination of promotion of protective factors, including resilience, and risk factor reduction. In adolescents, use of motivational interviewing has been shown to decrease risky sexual behaviors, help prevent unplanned pregnancy, increase physical activity levels, and decrease substance use. Confidentiality is another essential component of care. The American Academy of Pediatrics (AAP) recommends use of the Strengths, School, Home, Activities, Drugs/substance use, Emotions/eating/depression, Sexuality, Safety (SSHADESS) screen for psychosocial assessment. Several other standardized, validated screening tools also may be valuable in guiding discussions and identifying risky behaviors. Sexual orientation, gender identity, religious, racial, and ethnic components of identity development should be addressed. The empowerment of adolescent patients to achieve personal independence in the health care setting is part of the transition from an adolescent approach to health care to an adult approach.

Case 1. MT is a 15-year-old adolescent girl who comes to your office for a health maintenance visit. Before the visit, you review MT’s medical record and note that she uses the pronouns “she” and “her.” As MT is being taken to an examination room, you overhear a tense exchange between MT and her mother. Her mother wants MT to take a pregnancy test because the mother is concerned about MT’s boyfriend. It is apparent when you enter the room that MT does not wish to be there.

Defining Adolescence and Changing the Paradigm of Care

Adolescence is a transitional period that includes important developmental milestones and the critical task of identity development.1 During this time, rapid changes in the body, brain, and emotions are driven by brain plasticity that creates the opportunity for peers and adults to support growth. However, there is a simultaneous increased susceptibility to mental health factors and effects of socioeconomic stressors, such as expanded adverse childhood events (ie, adverse events occurring outside the family setting).2,3 These may include effects of poverty, racism, and poor access to education and health.

Adolescence has different stages, dictated mostly by brain development, including early adolescence (ages 11-14 years), middle adolescence (ages 15-17 years), and late adolescence or early adulthood (ages 18-21 years).4 Also, it is known that brain development extends well into young adulthood, and that young adults (ages 21-25 years) have care needs similar to those of adolescents.4,5 This often is called the adolescent and young adult group, and the basis of care discussed here is generalizable for most of this group.

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