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    About this Episode

    Period pain is common and commonly impacts upon teens. While 90% of teens described experiencing pain, around 20-30% of teens missed out on school or other important activities due to period pain and associated symptoms.
    So what is the role of primary care clinicians when it comes to recognition and assessment of menstrual and cyclical pain? How can we educate and advocate for patients experiencing the impact of moderate and severe pain? What management options are available and accessible in primary care?

    Period Pain in teens- how can the GP help?

    In this episode, GP Bianca Forrester speaks with Gynaecologist (sub-specialising in Adolescents) Professor Sonia Grover.

    "No one should have their life messed up by period and cyclical pain."

    Shownotes:
    Sonia mentioned a validated tool for patients to use to assess their rate of menstrual bleeding: https://letstalkperiod.ca

    Bianca describes the UK Medical Eligibility Criteria (MEC) summary sheets to assess the relative risks of common contraception for a range of conditions and potential contraindications.
    https://www.fsrh.org/standards-and-guidance/documents/ukmec-2016-summary-sheets/

    Sonia describes LARCs- Long Acting Reversible Contraceptives:
    https://www.fsrh.org/standards-and-guidance/documents/ukmec-2016-summary-sheets/

    Menstrual management guidelines coming soon.....

    This Podcast was recorded "at home" on the 30th of March, 2021
    Presented by: Bianca Forrester
    Interviewees: Prof Sonia Grover- Royal Children's Hospital
    Produced by: Bianca Forrester
    Music: Space Cadet Lullabies
    Graphics: Gaal Creative

    The Maze Phase is a production of the University of Melbourne, Australia. The Maze Phase is licenced under Creative Commons, Copyright 2017, the University of Melbourne.

    Recent Episodes from The Maze Phase

    Neurodiversity and neurodevelopmental disorders in teens-How can the GP help?

    Neurodiversity and neurodevelopmental disorders in teens-How can the GP help?

    In this episode, GP Bianca Forrester speaks with child and adolescent psychiatrist Prof Sandra Radovini about increasing requests for neurodevelopmental disorder assessments in primary care. We talk about the issues that many young people are facing in getting back on track with school routines and why transitions have been particularly challenging for some young people.

    Shownotes:
    Best Practice Guidelines for the assessment and support of autism
    Australia's First National Guideline for the Assessment and Diagnosis of Autism Spectrum Disorders https://www.autismcrc.com.au/access/national-guideline
    Best Practice Guidelines for the assessment and support for ADHD
    Australian Evidence-Based Clinical Practice Guidelines for Attention Deficit Hyperactivity Disorder (ADHD)  https://adhdguideline.aadpa.com.au  

     Assessment Tools
    Autism: Social Responsiveness Scale, 2nd Edition SRS-2

    Identifies the presence and severity of social impairment within the autism spectrum and differentiates it from that which occurs in other disorders https://paa.com.au/product/srs-2/

     For ADHD:

    https://adhdguideline.aadpa.com.au/diagnosis/adhd-diagnosis/

    The Conners ADHD rating scale was mentioned

    https://www.webmd.com/add-adhd/childhood-adhd/conners-rating-scale

     Recommended article:

    MJA article- Andrew Whitehouse- Autism: Widely known, rarely understood

      For GPs recording Continuing Professional development:

    This podcast (and accompanying guidelines and article review) may contribute to 1 hours of Educational Activities. GPs may self-record their completion of the activity in their MyCPD account at https://mycpd.racgp.org.au and click on “Log” from the banner at top of screen. Note that it remains the GP’s responsibility to maintain evidence of the activity for their CPD log. Please contact your local faculty if assistance is needed in logging the activity.

     Training Calendar Mindful Centre 

    The skill development workshops are designed for professionals working with clients with autism. They focus on practical skill development for delivering a wide range of autism interventions

     https://mindful.org.au/asd-training/skill-development

    Self-paced Training modules in assessment

    https://ecommerce.unimelb.edu.au/faculty-stores/mindful-centre-for-training-research-in-developmental-health

    This Podcast was recorded over "zoom" in February 2023

    Presented by:  Dr Bianca Forrester, Senior Lecturer Primary care, Department of General practice and Primary care, University of Melbourne.

    Guest:  Prof Sandra Radovini, Child and Adolescent Psychiatrist and Director of Centre for Training and Research in Developmental Health

    Produced by: Bianca Forrester

    Music: Space Cadet Lullabies

    Graphics: Gaal Creative

    The Maze Phase is a production of the University of Melbourne, Australia. The Maze Phase is licenced under Creative Commons, Copyright 2017, the University of Melbourne.

    The Maze Phase
    en-gbMarch 14, 2023

    Part 2 -Young people in out of home care- How can the GP help?

    Part 2 -Young people in out of home care- How can the GP help?

    In this episode, GP Bianca Forrester continues the conversation with researcher Dr Susan Webster and Paediatrician Dr Karen McLean about overcoming the barriers that young people in out-of-home care face in accessing health care and supporting their health, social and educational transitions.

    "The single best contribution that doctors and nurses can make, is to form that ongoing therapeutic relationship with a person who has lived with this kind of adversity. That beyond anything else, can really help."

    "I think anything that keeps the young person engaged at school and learning, is going to be a positive influence on them...potentially lifelong."

    Shownotes:

    Karen Mclean’s research: https://www.mcri.edu.au/news/most-children-living-out-home-care-don’t-access-health-services

    Australian National Standards of care- https://www.dss.gov.au/sites/default/files/documents/pac_national_standard.pdf

    National Framework for Protecting Australia’s Children 2009 – 2020 https://www1.health.gov.au/internet/main/publishing.nsf/Content/cyp-oohc-framework

    National Clinical Assessment Framework for Kids in out-of-home-care https://www1.health.gov.au/internet/main/publishing.nsf/Content/cyp-oohc-framework

    Trauma informed care and practice for health services

    https://aci.health.nsw.gov.au/networks/mental-health/trauma-informed-care

    SAHMSA guidelines for Health Services

    https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf

    Children and young people in care Booklet

    https://www.ddwmphn.com.au/uploads/publications/CYPC_Final.pdf

    Victorian Government Policieis on Children in Out of home care at school

    https://www2.education.vic.gov.au/pal/supporting-students-out-home-care/policy?Redirect=1

    Leaving Plus care plan in Victoriahttps://providers.dffh.vic.gov.au/out-home-care

    Raising expectations University access program https://www.cfecfw.asn.au/raisingexpectations/
    For GPs recording Continuing Professional development:

    This podcast (and accompanying guidelines and article review) may contribute to 1 hours of Educational Activities. GPs may self-record their completion of the activity in their MyCPD account at https://mycpd.racgp.org.au and click on “Log” from the banner at top of screen. Note that it remains the GP’s responsibility to maintain evidence of the activity for their CPD log. Please contact your local faculty if assistance is needed in logging the activity.

    This Podcast was 

    The Maze Phase
    en-gbAugust 10, 2022

    Kids in out of home care- How can the GP help?

    Kids in out of home care- How can the GP help?
    In this episode, GP Bianca Forrester speaks with researcher Dr Susan Webster and Paediatrician Dr Karen McLean about the health needs of kids in out of home care and how we can bridge the gaps they face in accessing health care.

    "One of the things to keep in mind for these young people is that when abuse or neglect has occurred, it has been in the privacy of the young person's home. Their parents may not have accessed health care....so kids may have big gaps in their health and medical care."

    "They do know what is most important to them and they want to be listened to and heard. Something really wonderful that GPs and nurses (and all of us) can do clinically is to respect their views and try to meet them where they are at."

    Shownotes:
    National Clinical Assessment Framework for Kids in out-of-home-care
    ·Susan recommends the following resource: https://www.ddwmphn.com.au/uploads/publications/CYPC_Final.pdf
    Susan mentioned the Snap that Stigma website https://create.org.au
    ·Karen discusses Trauma informed care and recommends: https://aifs.gov.au/cfca/sites/default/files/publication-documents/cfca37-trauma-informed-practice.pdf

    HEADSS screening tool: https://www.rch.org.au/clinicalguide/guideline_index/Engaging_with_and_assessing_the_adolescent_patient/
    ·
    Aboriginal and torres strait islander child and young people are over represented in out of home care
    ·
    Karen Mclean’s research: https://www.mcri.edu.au/news/most-children-living-out-home-care-don’t-access-health-services
    ·
    ·
    National Framework for Protecting Australia’s Children 2009 – 2020 https://www1.health.gov.au/internet/main/publishing.nsf/Content/cyp-oohc-framework

    Leaving home care plan- Victoria https://services.dffh.vic.gov.au/leaving-care


    This Podcast was recorded over "zoom" in May-June 2022
    Presented by: Bianca Forrester
    Guests: Dr Susan Webster, Honorary Research Fellow, Department of General Practice, University of Melbourne
    Dr Karen McLean, Paediatrician Royal Children's hospital and Researcher Murdoch Children's Research Institute
    Produced by: Bianca Forrester
    Music: Space Cadet Lullabies
    Graphics: Gaal Creative

    The Maze Phase is a production of the University of Melbourne, Australia. The Maze Phase is licenced under Creative Commons, Copyright 2017, the University of Melbourne.
    The Maze Phase
    en-gbJune 20, 2022

    Recovery and resilience in teens- how can the GP help?

    Recovery and resilience in teens- how can the GP help?
    In this episode, GP Bianca Forrester speaks with Professor of Public health Professor Lisa Gibbs Melbourne School of Population and Global Health
    "The conversation needs to be around strengths and vulnerabilities and how do we provide opportunities for kids to demonstrate their competence and supports where it's needed and when it's needed."

    Shownotes
    Prof Lisa Gibbs’ research
    https://findanexpert.unimelb.edu.au/profile/187995-lisa-gibbs
    Article referenced: Giving Students time for recovery and learning

    Risk resilience framework
    included on page 57 of the
    Adolescent Health GP Resource kit
    2nd edition
    By Peter Chown, Dr Melissa Kang, Dr Lena Sanci, Verity Newnham and Clin Prof David Bennett AOy Peter Chown, Dr Melissa Kang, Dr Lena Sanci, Verity Newnham and Clin Prof David Bennett AO
    A collaboration between NSW CAAH and NSW Transcultural Mental Health Centre.

    https://www.health.nsw.gov.au/kidsfamilies/youth/Pages/gp-resource-kit.aspx
    Page 57 in this section:

    Psychological First Aid (PFA)
    Principles of PFA:
    · Sense of Safety
    · Calming
    · Self-Efficacy
    · Connectedness
    · Hope

    https://www.health.vic.gov.au/worker-health-wellbeing/psychological-first-aid-for-post-incident-support

    Mental Health recovery: CHIME Bianca mentions the CHIME conceptual framework. Here’s the systematic review:
    Leamy M, Bird V, Le Boutillier C, Williams J, Slade M.Br J Psychiatry. 2011

    Kate Brady’s research
    Stressors and Supports in Post disaster Recovery: Experiences After the Black Saturday Bushfires

    While not mentioned in this episode, we can recommend this review of the evidence:
    Bushfires and Pandemics: supporting student and teacher wellbeing post crisis
    for recommen
    The Maze Phase
    en-gbMarch 04, 2022

    Working with Families

    Working with Families
    In our last podcast, Old enough to have a medicare care but too young to vote, we discussed the rights and responsibilities of young people independently accessing health care services. This episode continues that conversation. Bianca speaks with Sandra Radovini about when it might be best practice to facilitate family involvement and how to navigate that fine balance between supporting young people's independence and choices with their best interests in supported health care. Importantly, we discuss some of the nuances such as timing and risk, some of the reasons for resistance and how to prepare parents and carers for these sensitive consultations.

    This Podcast was recorded "at home" in November, 2020
    Presented by: Dr Bianca Forrester, Department of General Practice, University of Melbourne
    Guest: A/Prof Sandra Radovini - Director, Mindful-Centre For Training & Research, Department of Psychiatry
    Produced by: Bianca Forrester
    Music: Space Cadet Lullabies
    Graphics: Gaal Creative

    The Maze Phase is a production of the University of Melbourne, Australia. The Maze Phase is licenced under Creative Commons, Copyright 2017, the University of Melbourne.
    The Maze Phase
    en-gbJanuary 30, 2022

    Old enough for a medicare card, too young to vote - the medico legal framework

    Old enough for a medicare card, too young to vote - the medico legal framework
    Young people have the right to access health services independently; as early as they are able to access them. As health care professionals, there are a number of medico-legal and ethical considerations that may play out in any health care consultation with teens.

    Firstly, we have a duty of care to assess their competence and maturity as it pertains to decision making around the treatment goal proposed. We can assist them on their help seeking journey by creating opportunities to develop health literacy and to participate in making decisions appropriate to their age and developmental stage. Judgement must also be made about whether the teen can manage the health care journey independently or when parent support is required. Finally, in the case where family based care is recommended but the clinician faces resistance from the teen, how does the clinician balance these considerations so as to maintain trust in the therapeutic relationship and appropriate care for the teen?

    In this episode, we’ll be talking a deeper dive into the medico legal frameworks and ethical principles that we operate within when we provide care primary care services to young people independently seeking support. I'll be speaking with expert colleagues in the field of adolescent healthcare, regular contributors paediatrician Prof Susan Sawyer and child and adolescent psychiatrist, A/Prof Sandra Radovini.
    We’ll be discussing young peoples needs, their rights, and their responsibilities when it comes to participating in patient centred care. We'll be discussing the skills and capacities that are required and how we, as GPs and nurses, can assist young people to build these skills and support them on their journey either independently or alongside families.
    Including a discussion on:
    -the mature minor assessment in Australia
    -confidentiality
    -patient centred and transitional models of adolescent health care
    -the young person's rights and responsibilities in healthcare
    -working with and alongside families in practice
    -best practice approaches to working with young people either independently or with families

    For more information, we recommend this practical guide for GPs and nurses:
    Adolescent Health GP Resource Kit, 2nd edition
    By Peter Chown, Dr Melissa Kang, Dr Lena Sanci, Verity Newnham and Clin Prof David Bennett AOy
    https://www.health.nsw.gov.au/kidsfamilies/youth/Documents/gp-resources-kit/gp-resource-kit-sect2-chap6.pdf

    This Podcast was recorded "at home" in November, 2020
    Presented by: Dr Bianca Forrester, Department of General Practice, University of Melbourne
    Guests: Prof Susan Sawyer- Centre of Adolescent Health, Royal Children's Hospital, Department of Paediatrics
    A/Prof Sandra Radovini - Director, Mindful-Centre For Training & Research, Department of Psychiatry
    Produced by: Bianca Forrester
    Music: Space Cadet Lullabies
    Graphics: Gaal Creative

    The Maze Phase is a production of the University of Melbourne, Australia. The Maze Phase is licenced under Creative Commons, Copyright 2017, the University of Melbourne.
    The Maze Phase
    en-gbJune 18, 2021

    Period pain in teens

    Period pain in teens
    Period pain is common and commonly impacts upon teens. While 90% of teens described experiencing pain, around 20-30% of teens missed out on school or other important activities due to period pain and associated symptoms.
    So what is the role of primary care clinicians when it comes to recognition and assessment of menstrual and cyclical pain? How can we educate and advocate for patients experiencing the impact of moderate and severe pain? What management options are available and accessible in primary care?

    Period Pain in teens- how can the GP help?

    In this episode, GP Bianca Forrester speaks with Gynaecologist (sub-specialising in Adolescents) Professor Sonia Grover.

    "No one should have their life messed up by period and cyclical pain."

    Shownotes:
    Sonia mentioned a validated tool for patients to use to assess their rate of menstrual bleeding: https://letstalkperiod.ca

    Bianca describes the UK Medical Eligibility Criteria (MEC) summary sheets to assess the relative risks of common contraception for a range of conditions and potential contraindications.
    https://www.fsrh.org/standards-and-guidance/documents/ukmec-2016-summary-sheets/

    Sonia describes LARCs- Long Acting Reversible Contraceptives:
    https://www.fsrh.org/standards-and-guidance/documents/ukmec-2016-summary-sheets/

    Menstrual management guidelines coming soon.....

    This Podcast was recorded "at home" on the 30th of March, 2021
    Presented by: Bianca Forrester
    Interviewees: Prof Sonia Grover- Royal Children's Hospital
    Produced by: Bianca Forrester
    Music: Space Cadet Lullabies
    Graphics: Gaal Creative

    The Maze Phase is a production of the University of Melbourne, Australia. The Maze Phase is licenced under Creative Commons, Copyright 2017, the University of Melbourne.
    The Maze Phase
    en-gbApril 21, 2021
    reproductive health
    endometriosis
    period pain
    adolescent health
    adolescent gynaecology

    Eating Disorders in teens

    Eating Disorders in teens
    Eating disorders and disordered eating exist along a spectrum. When considered together, Eating disorders and disordered eating are estimated to affect over 16% of the Australian population. The lifetime prevalence of eating disorders in women is about 8.5% and 2.2% for men and prevalence has been increasing over time. Co-morbidities are common and importantly the mortality rate for people with eating disorders is significantly higher than that of the average population and among the highest for a psychiatric illness.
    So what is the role of primary care clinicians when it comes to identification, assessment and management of Eating disorders and disordered eating? How can we implement a best practice approach to care along the spectrum of disorders and severity and how can we best work with available resources to achieve good outcomes over time.
    Eating disorders in teens- how can the GP help?

    In this episode, GP Bianca Forrester speaks with Paediatrician Michele Yeo and and GP expert in eating disorders Jenny Conway

    Shownotes:
    1)Eating disorders Queensland resource “Understanding eating disorders”
    2) NEDC website
    3) Jenny mentions Mental Health screening tools
    K10- https://www.blackdoginstitute.org.au/wp-content/uploads/2020/04/k10.pdf
    Dass 21, RCADS-headspace clinical toolkit https://headspace.org.au/clinical-toolkit/anxiety/
    For for more information about identifying eating disorders in primary care:
    4)Eating Disorders examination- Questionnaire
    5) Self-help guides
    Self help and family support: The Butterfly Foundation https://butterfly.org.au
    Inside out institute: https://insideoutinstitute.org.au
    6) Maudesley model from the UK
    Evidence based treatment:
    7)Australian psychological society- therapist finder
    APS website:
    The Maze Phase
    en-gbMarch 19, 2021
    mental health
    eating disorders
    adolescent health

    Understanding self-harm and suicidal behaviours

    Understanding self-harm and suicidal behaviours
    In this episode, GP Bianca Forrester and Child and Adolescent Psychiatrist A/Prof Sandra Radovini tackle the tricky topic of self-harming and suicidal behaviours. Sandra describes the key elements of assessment and management for self-harming behaviours themselves and the presence of self-harm as a red flag for suicidal behaviours. They discuss the importance of formal training and support when working with young people who might be experiencing these behaviours. Sandra describes how we might better understand what we can work with and when we need to refer. Sandra also reinforces the the importance of working with supports.



    Patient information about Self Harm

    Safety Planning resources
    For an explanation of safety planning
    or directly link to the app:


    Training and education resources
    Asist training

    Orygen training

    Headspace training for GPs


    Phone Counselling and Support
    Where people are in crisis and need to talk to someone about their distress or trauma, there are a range of organisations listed below that can assist them.
    beyondblue
    1300 22 4636
    beyondblue is a national organisation that has a range of information and resources associated with depression and anxiety. Useful resources and further information about beyondblue programmes are available on its website at www.beyondblue.org.au or by contacting its Support Service on 1300 22 4636 (toll free). The Support Service runs 24 hours a day, seven days a week. All calls are one-on-one with a trained mental health professional, and completely confidential.

    Lifeline Australia
    13 11 14
    Lifeline Australia provides a free, confidential and anonymous, 24-hour telephone counselling service for adults needing emotional support. Lifeline Australia also has a range of information and resources available from their website, about providing care in times of crisis.

    Kids Help Line
    1800 55 1800
    A number of children and youth may also need emotional. Kids Help Line is a free and confidential, telephone counselling service for 5 to 25 year olds in Australia.

    Black Dog Institute
    The Black Dog Institute provides a 24 hour
    The Maze Phase
    en-gbJuly 09, 2020
    mental health
    self harm
    adolescent health
    suicidal risk

    Disruptive behaviour in teens

    Disruptive behaviour in teens
    In this episode, GP Bianca Forrester and Child and Adolescent Psychiatrist A/Prof Sandra Radovini have a conversation about disruptive behaviour in school aged teens. Bianca asks Sandra to help her to organise her thinking about this group of presentations. Sandra frames up this common presentation by describing how “all behaviour has meaning”. So, how do we begin to understand the feelings behind the behaviours? How do we understand these teen’s needs? How do we engage the young person in a collaborative relationship? And how can we as GPs and practice nurses help?

    Sandra refers to the AMAZE website for information for health professionals, including links to online training.

    This Podcast was recorded at the PodHub on the 4th of June, 2019
    Presented by: Bianca Forrester
    Produced by: Bianca Forrester
    Audio Engineering: Chris Hatzis
    Post-Production: Arch Cuthbertson
    Music: Space Cadet Lullabies
    Graphics: Gaal Creative

    The Maze Phase is a production of the University of Melbourne, Australia. The Maze Phase is licenced under Creative Commons, Copyright 2017, the University of Melbourne.
    The Maze Phase
    en-gbJuly 08, 2020
    mental health
    behaviour
    adolescent health
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