Adolescent risk assessment and harm minimisation

Overview & Definition

A registrar sees a 16-year-old for a sports check. Vaping is "just social," mood is "fine," and the visit closes in eight minutes. Six weeks later the same teenager is in resus after a fentanyl overdose. The missed work was not a rare diagnosis. It was risk that nobody asked about, and a plan that demanded abstinence the young person could not yet give. [5] [7]

Adolescent risk assessment is structured inquiry across the domains that actually drive morbidity and mortality in young people — substance use, mental health and suicide, sexual and reproductive health, injury and violence, digital exposure, and social determinants. HEADSS (and its HEEADSSS expansion) is the interview framework; validated instruments are the adjuncts that sharpen specific domains. [1] [2]

Harm minimisation (often called harm reduction) is a pragmatic public-health stance: reduce the adverse consequences of a risk behaviour even when the behaviour itself continues. It does not abandon abstinence as one possible goal — it stops treating abstinence as the only acceptable outcome, because that stance pushes away the young people at greatest risk. [5] [7]

The clinical skill is the marriage of the two: assess risk thoroughly, then meet the young person at their readiness with a response that lowers harm today while keeping the door open for bigger change later. [4] [8]

[1] [4] [5]

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1. [1]Cohen E, Mackenzie RG, Yates GL HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. Journal of adolescent health : official publication of the Society for Adolescent Medicine, 1991.PMID 1772892
2. [2]Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of pediatrics & adolescent medicine, 2002.PMID 12038895
3. [3]Steinberg L A Social Neuroscience Perspective on Adolescent Risk-Taking. Developmental review : DR, 2008.PMID 18509515
4. [4]Levy SJ, Williams JF Substance Use Screening, Brief Intervention, and Referral to Treatment. Pediatrics, 2016.PMID 27325634
5. [5]Kimmel SD, Gaeta JM, Hadland SE, Hallett E, Marshall BDL Principles of Harm Reduction for Young People Who Use Drugs. Pediatrics, 2021.PMID 33386326
6. [6]Bagley SM, Hadland SE, Schoenberger SF, Gai MJ, Topp D, Hallett E Integrating substance use care into primary care for adolescents and young adults: Lessons learned. Journal of substance abuse treatment, 2021.PMID 34080547
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8. [8]Cushing CC, Jensen CD, Miller MB, Leffingwell TR Meta-analysis of motivational interviewing for adolescent health behavior: efficacy beyond substance use. Journal of consulting and clinical psychology, 2014.PMID 24841861
9. [9]Chadi N, Hadland SE Youth Access to Naloxone: The Next Frontier? The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2019.PMID 31648752
10. [10]MacArthur GJ, van Velzen E, Palmateer N, Kimber J, Pharris A, Hope V Interventions to prevent HIV and Hepatitis C in people who inject drugs: a review of reviews to assess evidence of effectiveness. The International journal on drug policy, 2014.PMID 23973009
11. [11]Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department. Archives of pediatrics & adolescent medicine, 2012.PMID 23027429
12. [12]Brent DA, Horowitz LM, Grupp-Phelan J, Bridge JA, Gibbons R, Chernick LS Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments. JAMA network open, 2023.PMID 36790810