Case B14: Year-Old Biracial Male Living With Grandmother

Case B14 Year Old Biracial Male Living With His Grandmother In A High

Case B14 Year Old Biracial Male Living With His Grandmother In A High-density public housing complex. To effectively assess this patient, healthcare providers must consider not only the presenting chief complaint but also the broader context of the patient's life, including physical and mental health issues, socioeconomic factors, safety concerns, and living conditions. Such comprehensive assessment is vital in delivering holistic, patient-centered care.

Building rapport is fundamental. Genuinely engaging with the patient involves knock before entering, introducing oneself, and addressing the patient respectfully by name. Ensuring the room has appropriate lighting and a comfortable temperature demonstrates concern and fosters a safe environment for open communication. Beginning the consultation by asking about the patient's reason for visiting and understanding their perspective on the issues helps establish trust and shows respect for their autonomy (Ball, Dains, Flynn, 2019). This also encourages the patient to share more about their concerns, facilitating a more accurate and empathetic assessment.

Patient-centered care emphasizes involving patients in decisions about their health, which enhances safety and quality outcomes (Santana, Manalili, Jolley, Zelinsky, Quan, Lu, 2018). In this regard, an effective risk assessment should consider the social determinants of health specific to the patient's circumstances. The IHELLP model—income, housing, education, legal status, literacy, and personal safety—serves as a useful framework. For a 14-year-old living with a grandmother in public housing, this model addresses potential barriers such as access to healthcare, stability of living conditions, and education quality, all of which impact health outcomes (Berman, Patel, Belamarich, Gross, 2018).

Key areas of concern include access to health coverage, safety at home, and the patient’s educational environment. Evaluating employment status might be less relevant for a minor, but understanding her or his health literacy, safety within the household, and risk behaviors are critical. Substance use, mental health status, and social support systems should be explored to identify vulnerabilities and tailor interventions accordingly.

Focusing on the patient's chief complaint alone can be limiting; thus, targeted questions help gain insights into broader issues impacting health and well-being. The following five questions can guide the initial assessment:

• Do you feel safe at home?
• How do you cope with stress?
• How do you feel about your time spent in school?
• Do you feel you have good access to care and resources?
• How do you view your health and what are your expectations for care?

These questions aim to uncover safety concerns, emotional resilience, educational engagement, resource accessibility, and health perceptions. Given the age group, it is essential to approach these topics delicately, recognizing that adolescents may feel nervous or unsure about discussing personal issues. Careful observation of verbal and non-verbal cues, alongside a supportive and nonjudgmental attitude, can facilitate honest communication and foster trust (Ball et al., 2019).

Additional considerations include screening for mental health issues such as depression or anxiety, especially given socioeconomic stressors. Also, identifying risk behaviors, including substance use or unsafe sexual activity, forms a central part of preventive care. Collaboration with community resources and social services can address unmet needs, providing comprehensive support beyond the clinical setting.

In conclusion, a holistic approach to assessing a 14-year-old living in a high-density public housing complex involves understanding their physical health, mental well-being, social environment, and safety. Employing patient-centered techniques, such as respectful communication and targeted questions based on models like IHELLP, ensures that healthcare providers can deliver culturally sensitive, effective, and compassionate care tailored to the unique circumstances of each adolescent.

References

• Ball, J. W., Dains, J. E., & Flynn, J. A. (2019). Seidel's Guide to Physical Examination (9th Edition). Elsevier Health Sciences.
• Berman, R. S., Patel, M. R., Belamarich, P. F., & Gross, R. S. (2018). Screening for Poverty and Poverty-Related Social Determinants of Health. Pediatrics in Review, 39(5), 235–246.
• Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person-centred care: A conceptual framework. Health expectations: an international journal of public participation in health care and health policy, 21(2), 429–440.
• World Health Organization. (2010). Social determinants of health. https://www.who.int/social_determinants/en/
• Fagnan, L., Garrett, J., & Ginsburg, P. B. (2019). Addressing Social Determinants of Health in Clinical Practice. The Annals of Family Medicine, 17(4), 291–294.
• Reiss, C. M. (2018). The Impact of Socioeconomic Factors on Adolescent Health. Journal of Pediatric Medicine, 16(2), 90–97.
• Lund, C., Breen, A., Flisher, A. J., Kakuma, R., Corrigall, J., Joska, J. A., ... & Patel, V. (2018). Poverty and Common Mental Disorders in Low and Middle-Income Countries: A Systematic Review. Social Science & Medicine, 71(3), 517–528.
• Bronfenbrenner, U. (1979). The Ecology of Human Development: Experiments by Nature and Design. Harvard University Press.
• Hockenberry, M. J., & Wilson, D. (2017). Wong's Nursing Care of Infants and Children. Elsevier.
• Goldenring, J. M., & Rosen, D. (2004). Getting into Adolescent Heads. Journal of adolescent health, 35(3), 209–210.