Anticipatory Guidance for 17-Year-Olds
Comprehensive anticipatory guidance for 17-year-olds should include preventive health visits, mental health screening, sexual health education, safety counseling, and transition planning to adult healthcare.
Preventive Health Services
- Annual preventive health visits are essential for all 17-year-olds, as recommended by the American Academy of Pediatrics (AAP) 1
- These visits should be exempt from copayments, coinsurance, and deductibles to reduce barriers to care 1
- Visits should include:
- Disease detection and prevention
- Health promotion
- Anticipatory guidance addressing physical growth and development
- Assessment of social and academic competence
- Evaluation of emotional well-being
- Risk reduction counseling
- Violence and injury prevention 1
Mental Health Screening
- Implement routine screening for depression and anxiety at all visits for 17-year-olds 2, 3
- The US Preventive Services Task Force recommends screening adolescents (12-18 years) for major depressive disorder when systems are in place to ensure accurate diagnosis, psychotherapy, and follow-up 4
- Use validated screening tools:
- Patient Health Questionnaire-2 (PHQ-2) as an initial screen
- If PHQ-2 score is ≥3, administer PHQ-9 5
- Computerized self-administered screening tools before visits can improve doctor-patient discussions of mental health issues 6
Sexual Health Education and Safety
- Provide education on sexual assault prevention:
- Identifying high-risk situations (parties with unknown people, meeting internet contacts, walking alone at night)
- Avoiding risky behaviors (accepting drinks from strangers, excessive alcohol consumption)
- "Buddying up" in social situations
- Dangers of sexting and sharing explicit images 1
- Discuss consent, healthy relationships, and reproductive health options
- For male adolescents, address specific concerns related to masculinity and sexual health 7
Risk Behavior Prevention
- Counsel on substance use prevention:
- Risks of alcohol, tobacco, marijuana, and other drugs
- Strategies to resist peer pressure
- Legal consequences of substance use
- Discuss driving safety:
- Dangers of distracted driving (texting, phone use)
- Risks of driving under the influence
- Importance of seatbelt use
Transition to Adult Healthcare
- Begin discussing transition to adult healthcare providers
- Educate about:
- Taking responsibility for medication management
- Making independent healthcare appointments
- Understanding health insurance
- Knowing personal medical history
- Recognizing when to seek medical care
Common Pitfalls in Adolescent Care
Inadequate time allocation: Comprehensive adolescent visits require sufficient time to address multiple concerns. Schedule longer appointments when possible.
Confidentiality concerns: Adolescents may withhold information if confidentiality is not assured. Clearly explain confidentiality policies and limitations.
Focusing only on physical health: Mental health and psychosocial issues are equally important. Use a holistic approach that addresses all aspects of health.
Neglecting transition planning: Many adolescents are unprepared for adult healthcare. Begin transition discussions early to ensure continuity of care.
Overlooking screening opportunities: Implement systematic screening protocols to ensure mental health, substance use, and other risk factors are not missed.
By implementing comprehensive anticipatory guidance for 17-year-olds, healthcare providers can help ensure a successful transition to adulthood with optimal physical and mental health outcomes.