Adolescent Health teaching tool for UG medical teacher.pdf

Excellent teaching tool for Medical Teachers

1. Adolescent Health
Dr PIYUSH GUPTA
Chapter 5

3. Definition and Importance of Adolescent Health
•Adolescenceisaperiodoftransitionbetweenchildhoodandadulthood
•Atimeofrapidphysical,cognitive,social,andemotionalmaturing.
Definitionofadolescence
•WHOdefines“adolescence”asagebetween10and19years
•GovernmentofIndia(NationalYouthPolicy)definesadolescenceas13–19years
•“Youth”referstoages15–24years.GovernmentofIndiadefinesthisas15–35
years
•“Youngpeople”referstoages10–24years
•“Youngadults”referstoages20–24years
•Earlyadolescencereferstoage10–13years,middleadolescencereferstoage14–
16yearsandlateadolescencereferstoage17–19years.

4. Girls
•Girlsdevelopbreastbudsasthefirstsignofpuberty
•Approximately1yearafterbreastbudding,girlsreachtheirpeakheightvelocity,and1year
latermenarcheensues.Aftermenarche,agirlusuallygrowsonlyanadditional4–5cm.
Boys
•Onsetisheraldedbyanincreaseintesticularvolume,followedbypubichairgrowth,then
enlargementofthepenis.
•Peakheightvelocityoccurs2yearsaftertheonsetoftesticularenlargement.Adolescents
gainabout15–25%oftheirfinaladultheightduringtheirpubertalgrowthspurt.
Important
•Pubertaldevelopmentstarts1–2yearsearlieringirlsascomparedtoboys.
•Appearanceofsecondarysexualcharactersbeforetheageof8yearsingirlsand9yearsin
boys,andnonappearanceofsecondarysexualcharactersbytheageof13yearsingirlsand
14yearsinboysisconsideredabnormal.
•Agirlwhodoesnotmenstruateby16yearsshouldbethoroughlyevaluated.
Pubertal Changes

5. Sequence of Maturity Changes

6. Tanner Sexual Maturity Rating: GIRLS

7. Tanner Sexual Maturity Rating: Boys

8. 1.Bodilychangescauseemotionalstressandstrainaswellasabruptandrapidmood
swings.
2.Sexualattractionleadstoadesiretomixfreelyandinteractwitheachother.
3.Adolescenceischaracterizedbyanemergingcapacitytoreasoninanincreasingly
moresophisticatedmanner.
4.Adolescentshaveasenseofuniquenessandpersonalinvulnerability.
5.Thissenseofpersonalinvulnerability,coupledwithadesiretotestandmasterand
theirnewlyemergingphysicalandmentalcapabilities,mayalsoexplaintherisk-
takingbehaviorsobservedduringthisage.
Cognitive and Developmental Changes

9. Adolescenceiscustomarilydividedintothestages:
(1)Early(age11–14years),
•Characterizedbyafocusonthephysicalchangesthataccompanypubertyand
byconcretethinking.Separationfromparentsandtheriseinpeergroup
influencebeginsduringthisstagebutisnotprominent.
(2)Middle(age14–17years)and
•Peergroupinfluenceandconflictswithparentspeak.Risk-takingbehaviors,
becomecommon.Concernsaboutone’sdevelopingsenseofselfandautonomy
becomeincreasinglyimportant.
(3)Late(age17–21years)(Table5.4).
•Thefocusshiftstodevelopingthecapacityforintimacyinrelationshipsand
definingone’scareergoalsandplaceinsociety.
PHASES OF ADOLESCENCE

10. PHASES OF ADOLESCENCE

12. ChangesinAdolescence
1.Adolescenceisaccompaniedbyphysical,cognitive,emotional,socialand
behavioralchangesduetointerplayofvarioushormonesduringpuberty.
2.Physically,anindividualgainsthefinal15–20%ofadultheight;50%oftheadult
bodyweight;and40%oftheadultskeletalmassinadolescence.
3.MarshallandTannerhavedescribedtheappearanceofsecondarysexual
characteristicsassexualmaturityratings(SMR).
4.Adolescenceiscustomarilydividedintothethreestages:early(11to14years),
middle(14to17years)andlate(17to21years).
IN A NUTSHELL

13. 1.Medicaldiseases:Asthma,respiratoryinfections,tuberculosis,precociousor
delayedpubertyshortstature,andchronicdisorderssuchasdiabetes,celiac
diseases,heartdiseases,etc.
2.Consequencesofrisk-takingbehavior:Accidentsandinjuries,violence,homicide,
suicide,substanceabuse
3.Nutritionalproblems:Undernutrition,irondeficiency,obesity,andeating
disorders—anorexianervosa,bulimia
4.Reproductivehealthproblems:Teenagepregnancy,abortion,menstrualproblems,
andreproductivetractinfections
5.Mentalhealthproblems:Substanceabuse,violence,depressionandsuicide,
learningdisorders,andotherpsychiatricdisorders
Adolescent Health Problems

14. 1.Nutritional problems
2.Sexual and reproductive health problems (including HIV/AIDS)
3.Noncommunicable diseases
4.Mental health problems
5.Substance use and abuse (tobacco, alcohol, and other substances)
6.Injuries and violence (including gender-based violence)
7.Endemic and chronic diseases: TB, malaria, asthma
Priority Health Problems Affecting Adolescents

15. 1.Behaviorcontributingtounintentionalviolentinjuries
2.Tobaccouse
3.Alcoholandotherdruguse
4.Sexualbehaviorscontributingtounintendedpregnancy,STDandHIV
5.Unhealthydietarybehavior
6.Physicalinactivity
Priority Health-risk Behaviorsin Adolescents

16. Thesefactorsincreasethelikelihoodofadolescentsmakingdecisionsthatcontribute
positivelytotheirhealthanddevelopmentanddecreasethelikelihoodofengagingin
riskybehavior.
1)caringandmeaningfulrelationships;
2)positiveschoolenvironment;
3)structureandboundariesforbehaviors;
4)havingspiritualbeliefs;
5)encouragementofself-expression;and
6)opportunitiesforparticipationandcontribution.
PROTECTIVE FACTORS

17. HealthIssuesinAdolescence
1.Thoughadolescenceisconsideredrelativelyahealthyperiod,butmanyhealthrisk
behaviorssuchassmoking,alcoholconsumption,sedentarylifestyleareformedin
thisage,whichareresponsibleforsignificantmorbidityandmortalityintheadult
life.
2.Healthproblemsencounteredinadolescencecanbebroadlygroupedasmedical
andnonmedical.
3.Apartfrommedicalissues,mentalhealthissues,drugs,andinjuriesandviolence
arethemajorcausesofmorbidityandmortalityinadolescents.
4.Protectivefactorsincreasethelikelihoodofadolescentsmakingdecisionsthat
contributepositivelytotheirhealthanddevelopment,anddecreasethelikelihood
ofengaginginriskybehavior
IN A NUTSHELL

18. Adolescent Sexuality
A.Sex
•Thetermssexandsexualityoftenconfusetheadolescents.
•Thetermsexisoftenusedfortheintercoursewhereasitdenotesthebiological
differencebetweenwomenandmen.
•Thegoalofsexdriveisbiologicalsexualmaturity,i.e.,capacitytolove,mate,
reproduceandcarefortheyoungones.
B.Sexuality
•Itincludesthesumofperson’spersonality,thinkingandbehaviortowardsex.
•Itincludestheidentity,emotions,thoughts,actions,relationships,affection,
love,feelings,caring,sharing,andtheintimacythepersonhasanddisplays.
•Thenegativeaspectofsexualityincludessexualcoercion,eveteasing,sexual
harassment,rape,andprostitution.

19. •Adolescentsdevelopandbecomeawareoftheirsexualdrivesandfeelings.
•Theyalsotendtoexplorethevariousaspects/dimensionsofbeingsexual.
•Theyarelikelytobecuriousandtrytoexperiment.
•Manyadolescentsadopthigh-riskbehaviorduetothenumerousmythsandlack
ofskills—especiallytheabilitytonegotiateandtodealwithpeerpressure
effectively.
•Consequencesofunsafesexualbehaviorsincludeadolescentpregnancy,unsafe
abortions,andsexuallytransmittedinfections(STIs).
Adolescent Sexuality

20. •Globally,15%ofallbirthsaretowomen15–19yearsold.
•NineteenpercentoftotalfertilityinIndiaiscontributedbygirlsinthe15–19age
group.
Adverseeffects
˗↑morbidityandmortality.
˗Malnutritioninfetusandmother.
˗Prematurelabor,spontaneousabortion,andstillbirths.
˗Pregnancy-relatedhypertensionandanemia.
˗Youngmothersarealsolikelytohaveahigherincidenceofpoorchildcareand
poorchildfeedingpractices.
Adolescent Pregnancy

21. UnsafeAbortioninAdolescents
•Canresultincomplicationssuchashemorrhage,septicemia,injuries,infertility,
anddeath.
•Abortionalsohaspsychologicalconsequencessuchasdepression.
•Adolescentabortionsareestimatedgloballyat2.5millionperyear,
representing14%ofallunsafeabortions.Mostofthemareperformedillegally
orunderhazardouscircumstances.
SexuallyTransmittedInfections
•Eachyear,>1outof20adolescentscontractacurableSTI.
•Atleastone-thirdoftotalestimatednewSTIcasesoccurinyoungpeople.
•MorethanhalfofallnewHIVinfectionsreportedgloballyarefromtheage
groupof15–24years.

22. Adolescentsneedtohaveclear,accurateandpreciseinformationtounderstandthe
variousaspectsofhumansexuality,sexualrolesandresponsibilities.Promotingthe
sexualandreproductivehealthofadolescentsinvolvestheimplementationofthe
following:
Proper information that will help adolescents understand how their bodies work
and what the consequences of their actions are likely to be.
Social skills that will enable them to say no to sex with confidence and to negotiate
safer sex.
Counseling to make informed choices.
Health services can help adolescents to stay well, and ill adolescents get back to
good health.
PROMOTING THE SEXUAL AND REPRODUCTIVE HEALTH

23. AdolescentSexuality
1.Sexualityisbroadterm,whichincludesthesumofperson’spersonality,thinking
andbehaviortowardsex.
2.NineteenpercentoftotalfertilityinIndiaiscontributedbygirlsinthe15–19age
group.
3.Adolescentpregnancyandbreastfeedingputsbothmotherandchildathigherrisks
ofmorbidityandmortality.
4.Tofunctionaseffectiveandwell-adjustedadults,adolescentsneedtohaveclear,
accurateandpreciseinformationtounderstandthevariousaspectsofhuman
sexuality,sexualroles,andresponsibilities.
IN A NUTSHELL

24. Recommended Diet for Adolescents
•Increaseddemandofcaloriesandproteins
•The“growthspurt”resultsina50%increaseincalciumand15%increaseiniron
requirements.

25. •Conditioningfactors:Worminfestations,diarrhea,poorenvironmentalsanitation,
andmenstruationingirlscontributetomalnutrition.
•Culturalfactors:Foodhabitscustom,beliefs,tradition,attitudes,religion,foodfads,
cookingpractices,andsocialcustom.
•Socioeconomicfactors:Poverty,ignorance,insufficienteducation,lackofknowledge
regardingnutritivevalueoffoods,largefamily.
•Genderissues:Girlsarediscriminatedagainstinbothquantityandqualityoffood.
•Eatingpattern:DependanceonJUNCS,negativeinfluenceofmedia,andavailability
offastfoodonaclick.
Factors Influencing Adolescent Nutrition

26. •Adolescentgirlsareatparticularlyhighriskofanemia(upto66%)andmalnutrition.
•Evenboysarefoundanemicupto45%.
•Stuntingisprevalentin37.2%boysand41.0%girlsinIndia.
•Two-thirdssufferfromchronicenergydeficiencyofthethirddegree,withbody
massindexbelow16.
•Almosthalfoftheadolescentsarenotgettingeven70%oftheirdailyrequirements
ofenergy.
•Almost25%aregetting<70%ofRDAofproteins.
ADOLESCENTUNDERNUTRITION

27. •Deficienciesofiodine,iron,andvitaminB12arecommonamongadolescents,
causingdelayedgrowthspurt,stuntedheight,delayed/retardedintellectual
development,anemia,andincreasedrisksinchildbirth.
•Intakeofmostfoods,exceptcereals,millets,rootsandtubers,isbelowthe
referencedailyintake(RDI)inadolescents.
•Consumptionofgreenleafyvegetables,fruits,pulsesandmilkisgrosslyinadequate.
•Prevalenceofoverweightandobesityisalsohighbecauseofsedentarylifestyle.

28. Eating Disorders: Anorexia and Bulimia
•Eatingdisordersarepsychologicaldisordersthattypicallystartduring
preadolescenceoradolescenceandareoftenduetoextremedisturbanceineating
behavior.
•Threemostprevalentdisordersare:
˗Anorexianervosa,
˗Bulimianervosa,and
˗Bingeeatingdisorder.
•Symptomsofeatingdisordersincludethefollowing:adistortedbodyimage,skipping
mostmeals,unusualeatinghabits,frequentweighing,extremeweightchange,
insomnia,constipation,skinrash,dentalcavities,lossofhairornailquality,
hyperactivity,andhighinterestinexercise.

29. •Occursmorecommonlyinadolescentgirlsshortlyaftercompletionofpuberty.
•Characterizedbydeliberateweightlossinducedbytheadolescentbyreducingfood
intake,inrelentlesspursuitofthinness.
Etiology
•Commoningirlswithexcessivedependence,lowself-esteem,highanxiety,and
affectivedisorder.Theirfamiliesareoverprotective.
•Nowthoughttobeadisorderofmoodorprobleminidentitydevelopment.
•Acomplexinteractionbetweensociocultural,biologicalandpsychologicalfactors
contributes.
ANOREXIA NERVOSA

30. 1.Persistentrestrictionofenergyintakeleadingtosignificantlylowbodyweight.
2.Eitheranintensefearofgainingweightorofbecomingfat,orpersistentbehavior
thatinterfereswithweightgain.
3.Disturbanceinthewayone’sbodyweightorshapeisexperienced.
Diagnostic Criteria

31. Youngfemalesbegintoeatlessandlessfood,leadingtoprofoundweightlossand
emaciation.
Associatedwithself-inducedvomitingorpurging.
Theremaybeahistoryofexcessiveexercise,useofappetitesuppressants,ordiuretics.
Complainofabdominalpainandbloatingofabdomenevenwithingestionofsmall
amountsoffood.
Weightloss>30%leadstolethargy,cachexia,andgeneralizedweakness.
Thereisundernutritionofvaryingseverity,withresultingsecondaryendocrineand
metabolicchangesanddisturbanceofbodilyfunctionsincludingamenorrhea.
Themortalityis10%andisduetoelectrolyteimbalance,cardiacarrhythmiasorcongestive
heartfailure,hypothermia,andhypotension.Bonemarrowhypoplasia,constipation,
esophagitis,hypophosphatemia,potassiumdepletion,hypochloremicalkalosis,and
elevationofBUNmayalsobepresent.
Clinical Manifestations of Anorexia Nervosa

32. Treatmentinvolvesacombinedapproachof
(1)individualandfamilypsychotherapy,
(2)behavioralmodification,and
(3)nutritionalrehabilitation.
Thosewithassociateddepressionmayrequireantidepressants.
TREATMENT: Anorexia Nervosa
Roleofparents:Theyshouldbefullyinvolvedintheirchild’stherapy.Psychotherapy
helpschildrenimprovetheirself-esteem,peerrelationship,andresolvingparental
conflicts.

33. •Predominantlyseeninadolescentfemales
•Characterizedbyrecurrentepisodesofbingeeatingaccompaniedbypurging
throughvomiting,overuseoflaxatives,enemas,diuretics,fasting,orexcessive
exercise.
•Eatingbingesmayoccurasoftenasseveraltimesadaybutaremostcommonin
theeveningandnighthours.
BULIMIA NERVOSA

34. Theseepisodesmustoccuratleastonceaweekfor3monthstomeetthediagnosticcriteriafor
DSM-Vclassification.Someofthesalientfeaturesofthisconditionareasfollows:
•Rapidconsumptionoflargeamountsofhighcaloriefoodwithnoapparentchangeinweight.
•Bingingisoftenfollowedbypurging,whichisoftendonesecretly.
•Evidenceofbingeeating:Hidingfoodordiscardedfoodcontainersandwrappers,stealing,
hoardingfood.
•Evidenceofpurging:Frequenttripstobathroom,especiallyaftermeals,signsand/orsmellsof
vomiting,presenceofemptycontainersorpackagesofdrugssuchaslaxativesordiuretics.
•Excessiveexerciseorfasting,frequentweighing,peculiareatinghabitsorrituals,preoccupation
withfood,bodyweightandimage.
•Overachievingandimpulsivebehaviors.
Physicalsignsofbulimianervosaincludedentalenamelerosion,odoronthebreath,skinchanges
suchascalluses/scarringonthedorsumofhandscausedbyself-inducingvomiting,enlargement
ofsalivaryglands,andedema.
Clinical Features

35. •Earlydiagnosisandmanagementarethemainstay
•Requiresamultidisciplinaryteamapproachcomprisingofphysician,therapistanda
nutritionistmedicalandnutritionalinterventionwiththe
•Aimofrestoringweight,nutritionalrehabilitation,andtreatmentofcomplications.
•Family-basedtreatmentisoftenthemainstayofpsychologicalintervention.
•Coexistingmentalillnesssuchasanxietyanddepressionarealsotreated.
•Selectiveserotoninuptakeinhibitors(fluoxetine,sertraline,etc.)areusedin
resistantcases.
Treatment: Bulimia Nervosa

36. Mental Health Problems
PREVALENCE
•AsperWHO“globally,oneinseven10–19-year-oldexperiencesamentaldisorder,
accountingfor13%oftheglobalburdenofdiseaseinthisagegroup”andisconsidered
mostcommonnon-communicabledisease(NCD)inthisagegroup.
•Inanygivenyear,about20%ofadolescentswillexperienceamentalhealthproblem,most
commonlydepression,anxiety,orbehavioraldisorders.
•InIndia,theprevalenceofpsychiatricdisordersamongadolescentsunder16yearsis12.5%.
Inaddition,
•Almosthalfofthementalillnessesdiagnosedinadultshavetheironsetintheadolescent.
ETIOLOGY
Riskybehavior(suchasunsafesex,hazardous/drunkdriving,smoking),self-harm,physical
inactivity,educationalfailure,andschooldropoutareassociatedwithmentalhealthproblems.

37. •Mentalillnesscanpresentinavarietyofways.
•Changesinmoodandbehaviorsareimportantindicatorsofmentalwell-being.
•Unexplainedachesandpains,inabilitytoconcentrate,disruptionsinsleephabits,
changesinappetiteandeating,heightenedirritability,agitation,andmoodiness
shouldalerttopresenceofamentalillness.
•Persistenceofsymptomsfor>2weeksareimportant“Redflags”fordepression.
TheHEEADSSSapproach(Table5.7)canhelpthecliniciansassesswhetheran
adolescentismentallywellorilland,iftheyareill,toassesstheseverityofthe
illness.
ASSESSMENT

39. 1.Body image
2.Sexuality conflicts
3.Scholastic pressures
4.Competitive pressures
5.Relationship with parents
6.Relationship with siblings and peers
7.Finances
8.Decision about present and future roles
9.Career planning
10.Ideological conflicts
Areas of Stress in Adolescents
Common psychosomatic
symptoms include recurrent
abdominal pain, headaches,
chest pain, and chronic
fatigue. Nonspecific
symptoms include dizziness,
syncope and/or tiredness

40. •Askthisdirectlywithoutanyhesitation,e.g.,“Haveyoueverfeltsobadthatyou
feltlikecommittingasuicide?”
•Askingaboutsuicidalbehaviordoesnotprecipitateortriggerit.
•Anysuicidalideationshouldpromptamorecarefulassessmentofthepatient’s
suicideriskandmustincludeareferraltoamentalhealthexpert.
•Previoussuicideattemptsareoftenastrongriskfactorforfutureattempts.
•Ensurethatadolescentshaveaccesstoqualityandaffordablementalhealth
services.
Suicidal Behavior

41. •Illiteracy,economicbackground,unemployment,andfamilydisharmonyincrease
vulnerabilitytodrugabuse.
•Consumptionoftobacco,alcohol,andillicitsubstancesbyadolescentsisrising.
Tobacco
•Globally,300millionyoungpeople(10–24years)smoke.50%ofthesetodieof
tobacco-relateddiseases.
•Somebeginas10-year-old.Theearlieradolescentsstartusingtobacco,themore
likelythattheywillgetaddicted.
SUBSTANCE ABUSE

42. Alcohol
•Mostcommoncauseofsubstanceuserelateddeathofyoungpeople.
•Associatedwithpoorscholasticattainment,increaseddropoutfromschool,drink
anddrugdrivingdelinquency,earlypregnancyandfamilydifficulties.Associated
withgreaterlikelihoodofearlysexualinitiation.
Drugs
•Drugabusemustbediscussedfranklywiththeadolescents.
•Moreoftentheydonotadmitdoingdrugswhendirectlyaskedtellabouttheir
friends.
•UsetheCRAFTQuestionnaire.
SUBSTANCE ABUSE

43. 1.HaveyoueverriddeninaCardrivenbysomeonewhowashighorhadbeenusing
drugsoralcohol?
2.DoyoueverusealcoholordrugstoRelax,feelbetteraboutyourself,orfitin?
3.DoyoueverusedrugsoralcoholwhenyouareAlone?
4.DoyouForgetthingsyoudidwhileusingdrugsoralcohol?
5.DoyourfamilyorFriendsevertellyouthatyoushouldcutdownyourdrinkingor
druguse?
6.HaveyouevergottenintoTroublewhileusingdrugsoralcohol?Twoormore“Yes”
answerssuggesthighriskofaserioussubstance-useproblemorasubstance-use
disorder.
CRAFT Questionnaire to Detect Substance Abuse

44. Promotepositive,caringandsupportiverelationshipswithfamiliesandpeers,
teachers,andotheradults.
Ensurethatadolescents’livesarefreefromneglect,trauma,excessivestress,
violence,abuse,anddiscrimination.
Ensuregoodlivingconditionsincludingaccesstosportingfacilities.
Acceptdiversityamongadolescents.
Helpadolescentstodeveloplifeskillsincludingcommunication,decisionmaking,
negotiation,criticalthinking,stressmanagementskills.
Ensureaccesstoeducationalandvocationaltrainingtoenhancetheirabilitiesand
employmentopportunities.
Integratementalhealthpromotionandlifeskillsdevelopmentintheschool
curriculum.
PROMOTING MENTAL HEALTH

45. MentalHealthinAdolescence
1.InIndia,theprevalenceofpsychiatricdisordersamongadolescentsunder16years
is12.5%.
2.Nearly50%ofmentalhealthissuesdiagnosedinadultshavetheironsetinthe
adolescentperiod.
3.HEEADSSSapproachrelatedtomentalhealthcanhelptheclinicianstoassess
mentalwellbeingandtheirseverityinadolescents.
4.Someofthecommonmentalhealthproblemsprevalentinthisagegroupare
substanceabuse,violence,depression,suicide,learningdisorders,andother
psychiatricdisorders.
IN A NUTSHELL

46. Noncommunicable Diseases in Adolescents
1.Injuriesandviolence
2.Mentalhealthandsubstanceabusedisorders
3.Chronicrespiratorydisorders(asthma)
4.Musculoskeletaldisorders(lowbackpain,neck
pain)
5.Neurologicaldisorders(epilepsy,migraine)
6.Dermatologicaldisorders(dermatitis,acnevulgaris)
7.Endocrinedisorders(diabetes)
8.Hematologicaldisordersincludingmalignancies
9.Urogenitalanddigestivedisorders
10.Nutritionaldisorders:Irondeficiencyanemia),
overweight,obesity
In 2019, globally,
one in five deaths
among adolescents
were caused by
NCDs and estimated
to cause over half of
the disability-
affected life years
(DALYs).

47. NoncommunicableDiseasesinAdolescence
1.BehaviorsresponsibleforthemajorityofNCDsinadulthoodhavetheiroriginin
adolescence.
2.Physicalinactivity,unhealthydiet,tobaccouse,harmfuluseofalcohol,and
indicatorsofmetabolicsyndrome(highbloodpressure,highcholesterol,diabetes)
aresomeoftheimportantbehaviorsresponsibleforthemajorityofNCDsofadult
life.
3.Injuriesandviolenceincludingsexualviolenceisanimportantcauseofmorbidity
andmortalityamongadolescents
IN A NUTSHELL

48. Adolescent Health Checkup

49. COMMUNICATION AND COUNSELING
•Integralpartofmanagingadolescenthealthissues.
•Communicationisanexchangeofinformation,knowledge,ideas,orfeelings.Ina
face-to-facesituation,communicationisnotjustexchangeofinformation.
•Conveysone’sfeelings,byuseofgestures,facialexpressions,language,andthe
manneroftone.
•Helpsinbuildingbridgeswiththeclient
•Counselingisnotsimpleadvisingratheritishelpingpeopletoidentifyproblem,
makedecisions,andgivingthemconfidencetoputtheirdecisionintopractice.

50. •
G: Greet the person
• A: Ask how can I help you
• T: Tell them any relevant information
• H:V Help them to make decisions
• E: Explain any misunderstanding
• R: Return to follow-up for referral.
Steps of counseling: “GATHER”
Maintain confidentiality and involve parents in care of adolescents
Techniques of good communication
1.Creating a good, friendly first
impression
2.Rapport building during the first
session
3.Nonjudgmental, active listening
4.Providing information in the
simple way
5.Ask appropriate and effective
question

51. •H: Home living arrangements, relationships, supervision, childhood experiences,
family cultural background/s)
•E:Education,Employment
•A:Activities,Hobbies,andPeerRelationships
•D:DrugUse
•S:SexualActivityandSexuality
•S:Suicide,Depression,Anxiety,andMentalHealth
HEEADSSS tool for psychosocial assessment

52. Examiningtheadolescentsisatactfulissueandonemustbeawareofcertainlegal
implicationsaswell.
Explainnatureandthepurposeoftheexamination.
Obtaintheconsentoftheadolescentparent.
Ideallysamesexdoctorispreferable.
Theexaminationshouldensureprivacy.
Watchforanysignsofdiscomfortorpainduringtheexamination.
Afterdoingtheexaminationproperlyexplainthefindingsanditsimplications.
Physical Examination

53. •Encouragetheadolescentstoadopthealthpromotingbehaviorsandtoreduce
identifiedriskbehaviors.
•Encouragetoparticipateinactivitiesandremainfit.
•Promotingabstinenceorusecontraceptionforsexuallyactiveadolescents.
•Reductionofriskybehaviorsincludessmokingcessation,avoidingdrinkingand
drivingandlifestylechangesbyMotivationalinterviewing.
•Effortstoupdateimmunizations.Shouldoccurateachvisit.
˗Adolescents11-year-oldandoldershouldreceivediphtheriaandtetanustoxoids
(Td),MMR,andvaricellavaccine.
˗SeconddoseofMMRvaccineiftheyhavenotpreviouslyhadone.
˗ThreedosesofhepatitisBvaccine
HEALTH PROMOTION IN ADOLESCENTS

54. AdolescentHealthCheckup
1.Communicationandcounselingaretheintegralpartofmanagingadolescent
healthissues.
2.Privacyandconfidentialityaretheimportantpillarsofcounselinginadolescents.
3.“HEEADSSS”isapsychosocialscreeningtoolusedgloballythatcapturesalmostall
thedomainsaffectingthepsychosocialdevelopmentoftheadolescents.
4.Thecounselingprocessshouldfocusonencouragingtheadolescentstoadopt
healthpromotingbehaviorsandtoreduceidentifiedriskbehaviors.
5.Alladolescentsshouldundergophysicalexaminationaccordingtotheprescribed
norms.
IN A NUTSHELL

55. Adolescent Friendly Health Services
1.Availability,
2.Accessibility,
3.Approachability,
4.Acceptability,
5.Appropriateness,
6.Affordability.
Basic Principles: 6 As

56. 1.Screeningforhealthissues(includingproblembehaviors)
2.Manageandtreatillnessincludingotherhealthconcerns
3.Preventandrespondtohealthissuesthatcanendangeryounglives
4.Supportyoungpeopletoleadhealthylife,bymonitoring
5.Interactwithadolescentsattimesofconcernorcrisis
6.Providecounselingservicesonwiderangeofissues
7.Providehealthpromotionalandpreventiveservices
8.Earlyreferralforconditionsnotmanageableattheclinic
Attributes of Effective Adolescent Health Service

57. •Barrierrelatedtoadolescents:
–Discomfortwithperceivedclinicconditionorattitudes
–Concernoverlackofprivacyandconfidentiality
–Embarrassmentorshameatneedingreproductivehealthservices
•Barrierrelatedtohealthfacility:
–Lackofdesignatedspaceforadolescents
–Unsuitabletiming
–Locationanddistance
•Barrierrelatedtohealthprovidersandpolicies:
–Untrainedproviders
–Unempatheticandjudgmentalattitudeofprovidersandstaff
–Discriminatorypolicies
–Unclearlawsandpolicies
Barriers to Health Seeking Behavior by Adolescents

58. Whiledealingwithadolescents,theroleofhealthprovideristhreefold:
(1)Toreassuretheadolescentthathisorherdevelopmentisnormaloridentify
problemsthatmayrequirefurtherevaluationortreatment;
(2)Toassesstheadolescentandhisorherfamilyforfactorsthatmaypredispose
toorprotectagainsttheadolescent’spursuitofhealth-riskingbehavior,and
(3)Topromoteahealthylifestylethatwillcontinuethroughoutadulthood
ROLE OF HEALTHCARE PROVIDER AT THE ADOLESCENT HEALTH CENTER

59. AdolescentFriendlyHealthServices
1.Adolescentfriendlyhealthserviceisaformofservicedeliverysystemthatplays
animportantroleinhelpingadolescentstostayhealthyandtocompletetheir
journeytoadulthood.
2.The basic principles of adolescent health care are 6 “As”—availability,
accessibility, approachability, acceptability, appropriateness, affordability.
IN A NUTSHELL