Adolescent risk assessment and harm minimisation — formative SAQs

SAQ 1 — Cross-domain risk assessment (10 marks)

A 15-year-old presents with their parent for a sports medical. The parent answers every question. You secure time alone. The young person discloses occasional vaping, low mood for two weeks, and inconsistent condom use. ^{[1] [3]}

Questions

1. Define harm minimisation and contrast it with an abstinence-only stance. (3 marks) ^[4]
2. Outline how you would complete the risk assessment across all domains, naming the validated tools you would add where a lead appears. (4 marks) ^{[1] [2] [5]}
3. Describe the brief-intervention method you would use and why it fits adolescent development. (3 marks) ^{[7] [8]}

Model answer

Harm minimisation vs abstinence (3). Harm minimisation is a pragmatic public-health stance that reduces the adverse consequences of a risk behaviour even when the behaviour continues; abstinence remains one possible goal but not the only acceptable outcome. Abstinence-only messaging demands the behaviour stop now and treats relapse as failure, which disengages the highest-risk youth. Harm reduction keeps young people alive and in contact enough for bigger change. ^[4]

Risk assessment (4). Complete HEADSS/HEEADSSS across all domains: Home, Education, Eating, Activities, Drugs, Sexuality, Suicide/mood/Safety, strengths. Add validated tools where a lead appears: CRAFFT or a frequency-based screen for the vaping/substance lead; a mood/suicide instrument (ASQ or Columbia) for the low-mood lead, then a full suicide risk assessment if positive; sexual-health history with STI testing to disclosed sites and a coercion question asked separately. Move from universal inquiry to selective screening to indicated assessment as the history drives it. ^{[1] [2] [5]}

Brief intervention (3). Use motivational interviewing — open questions, affirmation, reflective listening, summaries — to evoke the young person's own reasons for change rather than lecture. This fits the dual-systems model: the reward system outruns prefrontal control through mid-adolescence, so willpower-only demands fail and reducing consequences works with the biology. ^{[7] [8]}