|Theme:||History taking / Adolescents|
|Suitable for:||Paediatric trainee (ST1-3), GP trainee|
|Clinical scenario:||15yo Luke has been brought to hospital by his foster parents when they found him in his bedroom with an empty packet of paracetamol and a bottle of vodka approx. 1/4 full. He wouldn’t talk to them about it and, although he came to hospital, he is keen to leave.|
|Information for candidate:||Please take a history from 15yo Luke. He has been brought to hospital by his foster parents when they found him in his bedroom with an empty packet of paracetamol and a bottle of vodka approx. 1/4 full. He wouldn’t talk to them about it and, although he came to hospital, he is keen to leave.|
|Information for actor:||The doctor in this scenario is going to take a history – the following information can be volunteered if you are asked (elaborate as you wish):
You have been in foster care for 3 years. There was significant domestic violence at home then your dad went to prison and your mum’s mental health deteriorated to a point where she couldn’t look after you. You recently moved placement and although these foster parents seem ok you are missing a foster brother you really got on with at your last placement.
Your foster brother was the only person you really confided in as you had similar family backgrounds so you felt that he understood. You have ‘mates’ at school but no one you would open up to.
You see your mum weekly but find this very difficult as she gets very tearful and upset. You saw her earlier in the day.
You have had low mood for some time and previous thoughts of self harm but today’s visit with mum was particularly upsetting and acted as a trigger for this overdose. You didn’t really intend to kill yourself, you just didn’t know how to manage your feelings. You weren’t sure what the OD was meant to achieve. It is not something you have done before. You have taken 16 x 500g paracetamol and drunk some vodka. You feel a little sick but mainly just want to leave hospital. You do not have suicidal intent.
You are really reluctant to stay in hospital. You don’t see why you need bloods etc as you’re feeling ok apart from nausea which you attribute to the vodka. You definitely don’t want to be admitted for a MH assessment but are not aggressive. If managed well you can be talked around.
Home: You live with your foster parents, you are the only child in the house.
Education: You used to enjoy school but over the last couple of years your grades and attendance have slipped.
Eating: Your eating is quite erratic. You don’t want to have meals with your new foster parents so often getting fast food in the evenings.
Activities: You enjoy football but don’t participate in any school activities/clubs
Drugs: You smoke cigarettes occasionally and drink at weekends, not excessively. No illicit drugs.
Sexuality: You have previously had a girlfriend but it wasn’t serious. You weren’t sexually active.
Suicide / depression: You have been struggling with your feelings since your family breakup. Your mood has deteriorated and thoughts of self harm emerged. You have fleeting thoughts of suicide but no active plans.
Safety: You use social media but haven’t given out personal details or arranged to meet anyone from the internet. There was violence at home before you were taken into care. There isn’t any in your foster home. There are some kids at school you think are involved in gangs but you stay away from them.
|Information for scenario lead:||You can remind the candidate of the format of the HEEADSSS assessment before the scenario.
Terminate the scenario when the candidate has finished taking the history
|Possible points for discussion in debrief:||HEEADSSS Assessment
Which (if any) parts of the HEEADSSS assessment were difficult to address?
What concerns do you have after speaking to this patient and who to discuss them with?
Depression and self harm – determining risk
Actions if a teenager refuses admission
Scenario contributed by Claire Strauss
The clinical details of this simulation scenario are not based on any one particular case. Similarity to any real life clinical scenario or child is purely coincidental.