CURRICULUM VITAE

 Nama : Dr. Mei Neni Sitaresmi, Ph.D,Sp.A(K)

 Tempat/Tanggal Lahir : Yogyakarta, 30 Mei 1965
 Alamat : Jl. Gejayan CT X no 18
Pelemkecut Yogyakarta 55282
 No.telp/fax/e-mail : (0274) 561616/(0274) 583745
 E-mail : msitaresmi@yahoo.com
 Institusi : Bagian Ilmu Kesehatan Anak
Fakultas Kedokteran UGM/
RSUP Dr. Sardjito, Yogyakarta
 Jabatan :
 Sekretaris Bagian Ilmu Kesehatan Anak Fakultas Kedokteran
UGM
 Anggota UKK Tumbuh Kembang-Pediatri Sosial, IDAI
EARLY DETECTION OF
PSYCHOSOCIAL PROBLEMS IN
ADOLESCENTS
Mei Neni Sitaresmi
FK UGM- RS DR Sardjito Yogyakarta
Adolescents

 10-19 years old

 20% of population,
85% live in developing
countries
 Most challenging
period in human
development
 A critical time of rapid
physical, psychological,
behavioral, spiritual
development
Adolescents

 no longer children but not yet adults

 “ healthy”
 they have survived the diseases of early
childhood, and the health problems associated
with ageing are still many years away
 are exposed to behaviour and
development risk
 Facts of adolescents (WHO, 2010)

 20% of adolescents experience mental illness:

 depression, substance abuse, suicidal , eating
disorders
 45% of new HIV infections worldwide are young
people
 11% of births worldwide are young women
  increase risk of daying both mother and
baby
 Increase number of undernourished as well as
obesity
Facts of adolescents (WHO, 2010)

 > 150 million adolescents use tobacco, and

this number is increasing globally
 Increase of harmful drinking
 reduces self-control and increases risky
behaviors lead to injuries  death
 Cause of death among adolescents:
 Unintentional injuries (road traffic injuries,
drowning and burn)
 Suicide
 violence in the community and family.
Why assess psychosocial health
in adolescents?
 Early initiation of heath risk behaviour
 continue beyond adolescents and
contribute adult health problems
 1/3 total disease burden in adults are
associated with conditions or behaviors
that began in youth ( tobacco use, a lack of
physical activity, unprotected sex or
exposure to violence)
Why assess psychosocial
health in adolescents?

 Engagment of multiple risk behaviour

simultaneously
 many adolescent health challenges are closely
interrelated and successful interventions in
one area can lead to positive outcomes in
other areas
Why assess psychosocial
health in adolescents?

 Increase number of chronic disease among

adolescence

 Psychosocial problems in adolescents are less

identified and not managed well
Psychosocial screening

 HEEADSS (Home, Education, Eating, peer-

related Activities, Drugs-tobacco-alcohol,
suicides -depression, Sexuality, Safety)
 CRAFFT (Car, Relax, Alone, Forget, Friends,
Trouble) Screening Questionnaires
 The Strengths and Difficulties Questionnaire
(SDQ)
 Pediatric Symptom Checklist (PSC-17)
 Pediatric Symptom Checklist (PSC-35)
HEEADSSS

 H- home
 E- education or emplyoyment
 E- eating and exercise
 A- activities and peer relationships
 D- drug use/ tobaco/ alcohol
 S- Sexuality
 S- Suicide and depression
 S- Safety
HEEADSS

 A screening tool for conducting a

comprehensive psychososial history and
health risk assessment in adolescence
 Identify specific risk factors
 Identify strenghts and protective
 Identify areas for intervention and prevention

Garrison W, Developmental-Behavioral pediatrics,2009

Conducting HEEADSS

 Introduce the assessment and explain what will

be done
 Reassure about confidentiality, look at the verbal
and non verbal responses
 Start with less sensitive areas, flexible
 Asking the sensitive queastion:
 Ask the permission
 Use a -3rd person approach
 Wrapping up
 disccus and give recomendation
 Follow up
Example of question
 Home
 Who lives with you
 What are relationships like at home?
 To whom are you closest at home?
 To whom can you talk at home?
 Education:
 What are your favorite subjects at school?
 Your least favorite subjects?
 How are your grades? Any recent changes?
Any dramatic changes in the past?
 Eating and exercise:
 What do you think would be a healthy diet?
 How much exercise do you get in an average
day? Week?
 What do you like and not like about your body?

 Peer- related activities:

 What do you and your friends do for fun? (with
whom, where, and when?)
 Do you participate in any sports or religious or
other activities?
Screening for drugs/
tobacco/ alcohol
 question:
 Do any of your friends use tobacco? Alcohol?
Other drugs?
 your family?
 Do you use tobacco? Alcohol? Other drugs?
 CRAFFT (Car, Relax, Alone, Forget, Friends,
Trouble) Screening Questionnaires
Knight J et al, Arch Pediatr Adol Med 2002;156: 607
 The CRAFFT Screening Questions
Harap menjawab semua pertanyaan dengan jujur; jawaban anda akan dirahasiakan

Bagian A
Selama 12 BULAN TERAKHIR, apakah anda: Jika anda Jika anda
menjawab
1. Meminum alkohol (lebih dari beberapa tegukan)? menjawab
TIDAK ke
SEMUA YA (A1
2. Menghisap marijuana atau ganja (A1,A2,A3), sampai A3),
jawab hanya B1 jawab B1
dibawah, sampai B6
3. Menggunakan zat-zat lain untuk bisa “high” kemudian STOP dibawah
“zat-zat lain” termasuk obat-obatan ilegal, dijual bebas
maupun diresepkan, dan hal-hal lain yang dihirup

Bagian B ya
ya
tida
k
1. Apakah anda pernah berkendara di sebuah mobil yang dikemudikan
oleh seseorang (termasuk anda sendiri) yang sedang “high” atau telah
menggunakan alkohol maupun obat-obatan?

2. Apakah anda pernah menggunakan alkohol atau obat-obatan untuk

menenangkan diri, merasa lebih baik /mudah menyesuaikan diri?

3. Apakah anda pernah menggunakan alkohol atau obat-obatan saat

anda sedang sendiri?

4. Apakah anda pernah melupakan hal-hal yang telah anda lakukan

selama menggunakan alkohol atau obat-obatan?

5. Apakah keluarga atau teman anda pernah mengatakan kepada anda

untuk menghentikan kebiasaan minum atau penggunaan obatobatan?

6. Pernahkah anda tersangkut masalah selama anda menggunakan

alkohol maupun obat-obatan?
Suicides and depression
screen
 Do you feel sad or down more than usual?
 Are you "bored" all the time?
 Are you having trouble getting to sleep?
 Have you thought a lot about hurting yourself
or someone else?
 Sexuality:
 Do you have boy friend or girl friend?
 Have you ever been in a romantic relationship
 Safety:
 Have you ever been seriously injured? (How?)
 Do you always wear a seatbelt in the car?
 Have you ever ridden with a driver who was
drunk or high? When? How often?
Pediatric Symptom Checklist

 the parent-completed version (PSC)

 the youth self-report (Y-PSC): 11-16 years
 PSC 35
 PSC 17 :
 internalization, eksternalization, inattention

Web site: http://psc.partners.org.

Strengths and Difficulties
Questionnaire (SDQ)
 3-16 year olds (parents report) ; 11-16 (self
report)
 a brief behavioral screening questionnaire , 5
subscale:
1) emotional symptoms (5 items)
2) conduct problems (5 items)
3) hyperactivity/inattention (5 items)
4) peer relationship problems (5 items)
5) pro-social behavior (5 items)
http://www.sdqinfo.org
Who-when should be screened?
 “healthy” puberty period
 Risk factors:
 Chronic illness
Goldenring and Cohen; Contemporary Paediatrics 2004

 Parental (teachers) concern

 Hacker KA, Pediatrics, 2006
 School problems
 “criminal”, abuse
Obstracels:
 Lack of:
 Knowledge , attitude (preventive and
psychosocial aspect is less importance)
 time
 resources for referral
 Ministry of Health: PKPR
 Committee on Psychosocial Aspects of Child and
Family Health and Task Force on Mental Health,
AAP, 2009