PHE1IDH Individual Determinants Of Health - ENQUIRY 2: Working with adolescents

SCENARIO:

Key people in the enquiry
LAUREN: a 16-year-old girl who lives with her mother, stepfather and half-brother
JULIE: Lauren’s 43-year-old mother
DAVID: Lauren’s 46-year-old stepfather who has an 8-year-old son, James, with Julie
ROB: a 44-year-old medical practitioner who is treating Lauren.
YOU: a graduate who is attending a four-day workshop on working with adolescents. Narrative of the case enquiry
Lauren is 16 years old, is doing her VCE, and lives in Ballarat with her family.
Lauren is the second of two children to her parents, who are now divorced. Lauren lives with her mum Julie (a librarian, 43), her stepfather David (a real estate agent, 46), and her younger half-brother, James (8). Lauren’s father Tony (an electrician, 48) lives not far away and she sees him whenever she wants. Lauren says she gets on well with both Julie and Tony, but describes David (her step-father) as “a waste of space”. Lauren also has an older brother, Mark (a student in Melbourne, 20), whom she says she “misses big time”. Lauren appears highly anxious and irritable much of the time and finds that she is always tired and not thinking as clearly as she was a few months back. Lauren suspects that she has glandular fever or chronic fatigue syndrome and has seen a GP on a number of occasions. She spends most of her time when she is not at work or school in her room going online, studying, or watching TV. She’s not doing very well at school, and the class teacher noticed that she always seems tired and is no longer as sociable as she once was. The teacher has since referred her to the school counsellor, but Lauren hasn’t gone, as she is sure her problems are related to having either glandular fever or chronic fatigue syndrome.
Lauren is asthmatic. She fractured her left wrist in a motor vehicle accident when she was in Year 10. While her wrist injury is something that troubles her occasionally, she played netball quite competitively until this season, but has given it up because of a medial ligament injury to her knee which she sustained in a recent game.
Lauren was in a motor vehicle accident which occurred when she was coming home from a party with her older brother Mark, and three friends – Mark’s best mate Cameron, Cameron’s girlfriend Jessica, and Jessica’s younger sister Sophie, who was Lauren’s best friend. Cameron was driving, and lost control of the car, which ran off the road and struck a tree. Jessica was in the front passenger seat with her window down. Jessica’s injuries were so serious that she had to have her left arm amputated below the elbow. The other passengers sustained relatively minor injuries.
Lauren, however, was sitting directly behind Jessica, and was injured when Jessica’s seat was pushed back in the impact. Since the accident, Lauren has put on weight, and hates how she looks now, but thinks that her weight will “just sort itself out”. She also feels “weird” around Sophie, and doesn’t really talk with her any more. Lauren has lost contact with most of her old friends. She now tends to only see a small group of new friends. They hang around at one of their homes most Friday and Saturday nights partaking in risky behaviours, such as drinking “pretty much anything they can get their hands on”, “just to have fun, you know, pass the time”. Lauren wakes up most Saturday and Sunday mornings feeling very hung over. As well as these issues, Lauren is not adhering to her asthma management regime which impacts negatively on her health. On Saturdays Lauren tends to spend most of the day switching between lying in bed and watching the TV. On Sunday she has trouble getting out of bed for her part-time job at the local bakery and has started showing up late for work. Her manager has recently given Lauren an official warning.

Lauren’s GP is Rob, who is 44, Rob is well respected in his profession and prides himself on his achievements. In his work with Lauren, Rob has suggested that Lauren would benefit from engaging in more physical activity, reducing her alcohol use, taking her asthma medication as recommended, and from broadening her social activities and increasing her social networks. Although her lack of activity, drinking and withdrawal behaviours are not the principal focus of Rob’s work with Lauren, Rob believes that change in these behaviours are critical to making progress with Lauren. Refer to the video of a session between
Lauren and Rob. Rob suspects that Lauren has not been following his advice, particularly in relation to her asthma management regime. When he talks to her about her behaviours, Lauren becomes visibly upset so he often redirects his discussion away from what Lauren should be doing. On these occasions he notices that Lauren’s mood lifts slightly and she appears a little more engaged for a short period of time before again showing signs of disinterest. Although Rob likes working with Lauren generally, he is finding himself becoming increasingly frustrated with her general lack of progress. In fact, he is wondering if Lauren’s general health and well-being are becoming worse rather than better in recent times so Rob suggests that Lauren’s mother and stepfather join them for one of the sessions. Refer to the video of a session between Rob, Lauren, Julie and David.