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PE6.1-12 | Adolescent Health — Assignment

CLINICAL SCENARIO

You will conduct (or simulate, using a standardised case vignette provided below) a structured adolescent health assessment using the HEEADSSS framework, document Tanner (Sexual Maturity Rating) staging and growth parameters, identify health concerns, apply knowledge of national adolescent health programmes (RKSK/AFHC), and formulate a person-centred management plan. This exercise builds the skills central to PE6.8 and integrates content from PE6.1–6.12, preparing you to deliver holistic, confidential, and culturally sensitive care to adolescents in Indian clinical settings.

Instructions

Using the case vignette below, complete each section of the structured write-up template. Where clinical examination findings are to be reported, use the provided data rather than invent your own. Apply clinical reasoning and knowledge of NMC-PE competencies throughout.

Case Vignette:
Sheetal, 15 years, female, presents to the Government Medical College AFHC with her mother. Her mother leaves after initial introductions, as per AFHC protocol. Sheetal's chief complaints are: irregular periods for 8 months, weight gain, and persistent low mood. Menarche was at 13 years. She is in Class 10 and struggling academically since 6 months. Physical examination: height 158 cm (50th centile), weight 65 kg (BMI 26 kg/m² — overweight for age), BP 126/80 mmHg, HR 80/min. Tanner staging: breasts — Stage 4; pubic hair — Stage 4; no facial hair or significant acne. Thyroid — not enlarged. Abdomen — no organomegaly. HEEADSSS screening reveals: parents separated (Home); failing 2 subjects (Education); skipping meals then overeating (Eating); withdrawn from sports (Activities); denies substance use (Drugs); reports one brief consensual relationship with a 16-year-old classmate (Sexuality); passive death wishes twice in the past month — denies active plan (Suicide/Depression); reports minor road-traffic incident as a passenger (Safety).

Step 1: Complete the HEEADSSS Documentation (all 8 domains).
Step 2: Document and interpret the Tanner/SMR staging findings.
Step 3: Interpret the growth parameters using IAP/WHO growth charts.
Step 4: Identify at least four health concerns or risks (from the history and exam).
Step 5: Classify relevant national programmes (RKSK thematic areas) applicable to Sheetal.
Step 6: Formulate a person-centred management plan addressing each concern.
Step 7: Address confidentiality considerations — what would you share with the mother, and why?
Step 8: Reflect on how you would build therapeutic rapport with Sheetal across future visits.

Length: 1,200–1,600 words across all sections (excluding headings)

What to Submit

HEEADSSS Documentation

Guidance: Document each of the 8 domains systematically: Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicide/Depression, Safety. For each domain, note the key finding from the vignette and any additional questions you would ask. Flag domains where further assessment is needed.

Tanner (SMR) Staging and Growth Assessment

Guidance: State Sheetal's Tanner stage for breast development and pubic hair. Calculate her BMI and interpret it using IAP growth reference charts (state percentile and classification: underweight/normal/overweight/obese). Comment on whether her Tanner stage is appropriate for her chronological age. Note any discordance between breast and pubic hair staging.

Identified Health Concerns and Risk Stratification

Guidance: List at least four health concerns (e.g., overweight/NCD risk, menstrual irregularity/possible PCOS, mental health — passive suicidal ideation, academic failure, eating pattern concerns). For each, state the risk level (low/moderate/high) and cite the competency that addresses it (e.g., PE6.11 for NCD/obesity, PE6.6 for mental health).

Applicable RKSK Thematic Areas and Programme Linkage

Guidance: Identify which of the 6 RKSK thematic areas (nutrition, reproductive-sexual health, substance use, mental health, NCDs, injuries/violence) apply to Sheetal's concerns. Note what specific RKSK/AFHC services she should be offered (WIFS, mental health counselling, NCD screening, reproductive health referral).

Person-Centred Management Plan

Guidance: For each identified concern, write one or two specific, measurable management actions. Include: (1) immediate actions (safety assessment, crisis counselling for passive death wishes); (2) short-term (4 weeks): investigations (fasting glucose, lipid profile, TSH, pelvic USS if indicated), referrals, WIFS initiation; (3) medium-term (3 months): follow-up schedule, weight management plan, menstrual diary review, school counsellor liaison. Mention who from the multidisciplinary team (paediatrician, counsellor, nutritionist, psychiatry) should be involved.

Confidentiality and Information Sharing

Guidance: Explain what information (if any) you would share with Sheetal's mother at this visit, and the ethical reasoning. Address: Does the passive suicidal ideation trigger a confidentiality breach? How would you handle the mother's questions about her daughter's 'relationship'? Apply the principle that confidentiality is breached ONLY for serious imminent harm.

Building Therapeutic Rapport

Guidance: Describe two or three specific strategies you would use at a subsequent visit to strengthen the therapeutic alliance with Sheetal (e.g., ensuring privacy, using open-ended questions, positive reinforcement, non-judgmental language, following her agenda). Reflect on one personal bias or assumption you may need to examine when working with adolescent patients.

Grading Rubric — Adolescent Health Case Write-Up Rubric

Criterion	Points	Full-marks descriptor
HEEADSSS documentation completeness and accuracy	20 pts	All 8 domains documented accurately with key findings; appropriate follow-up questions specified; flags high-risk domains (passive suicidal ideation, eating pattern) correctly.
Accuracy of Tanner staging interpretation and growth parameter assessment	15 pts	Tanner Stage 4 correctly identified for breast and pubic hair; BMI 26 kg/m² correctly classified as overweight for age using IAP growth reference; appropriate comment on pubertal concordance.
Identification and risk stratification of health concerns	20 pts	At least four concerns identified with risk levels; passive suicidal ideation correctly flagged as 'moderate to high' requiring same-day safety assessment; NCD/overweight, menstrual irregularity, and academic failure all addressed; competency codes cited appropriately.
Application of RKSK programme components and person-centred management plan	25 pts	Correct RKSK thematic areas mapped to each concern; specific AFHC services mentioned (WIFS, NCD screening, mental health counselling, reproductive health referral); management plan includes immediate, short-term, and medium-term actions with multidisciplinary team roles; investigations appropriate (TSH, FPG, lipid profile, ± pelvic USS).
Ethical reasoning on confidentiality and therapeutic rapport	20 pts	Confidentiality reasoning is accurate: passive ideation without plan does not trigger mandatory breach; information shared with mother is minimal and with Sheetal's agreement; relationship disclosure is protected; rapport strategies are specific, non-judgmental, and developmentally appropriate; personal bias examined thoughtfully.

PEER REVIEW

Review your peer's write-up against the rubric criteria above. For each of the five criteria: (1) state the rating you assign with a one-sentence justification; (2) identify ONE specific strength; (3) suggest ONE improvement. Be constructive and specific — cite the case vignette data to justify your comments. Avoid comments on writing style or length; focus on clinical and ethical reasoning.