Transcript Adolescent Care Committee Activities

SAVE THE GIRL CHILD
ADOLESCENT CARE
Concept Preparation:
Dr M.K.C Nair
Dir. Child Development Centre
Vice Chancellor
Kerala University of Health Sciences
Chairman: Dr Asok Adhao
National Coordinators For Adolescent Care:
Dr Susan Samuel
Dr Beena Johnson
Adolescent Care Committee
Plan of action
National level Training of Trainers (ToT) for
one/two resource persons nominated by state
IMA
State/Zonal level ToT for one resource person
per branch
The module prepared by the national committee
to be used for training at all levels- suitably
modified and tailor-made to the audience
Adolescent Care Committee
Activities
 Each branch to adopt one or more schools in each
academic year
 Conduct Adolescent counseling and training programs in
each selected school, in batches of 50 students per
session- one hour each
 The resource persons should also conduct at-least one
awareness session for school teachers under their areathree hours session, to enable the teachers to understand
and manage adolescent issues- as a batch of 30 teachers
 Resource persons should also conduct sensitization for the
branch members as to how to identify and manage
adolescent issues at the primary care level
Resource slides
Adolescent Characteristics
A – Aggressive, Anaemic, Abortion
D – Dynamic, Developing, Depressed
O – Overconfident, Overindulging, Obese
L – Loud but lonely & Lack information
E – Enthusiastic, Explorative & Experimenting
S – Social, Sexual, & Spiritual
C – Courageous, Cheerful, & Concern
E – Emotional, Eager & Emulating
N - Nervous, Never say no to peers
T – Temperamental, Teenage pregnancy
Adolescent Friendly Services
Key words
 Accessible
 Acceptable
 Comprehensive
 Equitable
 Friendly staff
Section. 1
Adolescent
Counselling
Services
There is a huge demand for
adolescent counselling services
Counseling is required for those who have;
Scholastic backwardness
Non-assertive adolescents
Adjustment & personality problems
Specific behavioural problems
Mental health issues
Common Psychological Problems
Scholastic (nearly 50%)
Love affair –issues
Family problems
Behavior problems
Substance abuse
Adjustment problems
Depression / Suicidal tendency
Scholastic Backwardness
Correctly Evaluate Poor Performance
Poor school
performance
Environment
Intelligence Subject problem
Poor fit
These students need special help
Mental illness
Dr.Paul Russell, CMC, Vellore
How to Promote Good Study Habits
1. Have regular study pattern – read tomorrow’s
topic once today, read daily lessons & revise.
2. Better concentration –write down key points and
repeat the same many times.
3. Reduce personal factors / distractions in studies
– set targets & insist on meeting the targets.
4. Promote ambition and motivation – internal
(from within) and external (enabling
environment)
Adolescent Counselling - Spectrum
Advice
– Not acceptable to adols
Guidance
– Eg. career guidance
Negotiation
– Marriage counselling!!!
Counselling
– Improve personal growth
Psycho therapy
– Subconscious issues
What is Counselling?
Counseling is not advising
Counseling do not solve all life’s problems
Counseling is aimed at helping people
make choices and act on them
Counseling is a learning process
Counseling enables personality
development
Counseling – ABC Analysis
Conation (behaviour)
Affect (feeling)
Cognition (thinking)
B – Behaviour
A-Antecedents
C – Consequence
Adolescent Mental Health Disorders
1. Related to puberty and Adolescence
The dependence - independence conflict
Doubts about sexual role and sexual
adequacy and sexual problem
Peer group influences
Family development problems
‘Adolescent adjustment reaction’
Adolescent Mental Health Disorders
2. Unresolved childhood disorders
These are disorders of childhood which
continue into adolescence, like:
Conduct disorders
Hyperkinetic disorders
Autism spectrum disorders
Specific learning disabilities
Adolescent Mental Health Disorders
3. Adult type disorders with first
appearance in Adolescence
Anxiety disorders
Generalize anxiety
Phobia
Obsessive Compulsive Disorders (OCD)
Post Traumatic Stress Disorders (PTSD)
Depression
Substance abuse
Psychosis – Schizophrenia
Personality disorders
BASICs for evaluating an Adolescent!
Behaviour
Affect /Emotions
Somatic symptoms
Interpersonal relationships
Cognition (thinking)
Oppositional Defiant Disorder 
Conduct Disorder 
Juvenile Delinquency
1.Dissocial
2.Defiant
3. Aggressive
Mental Health Issues
Symptoms to Disorder Transition
1. Symptoms out of proportion to cause
2. Definite bodily symptoms present
3. Avoidance – bodily symptoms severe –
not able to do even routine activities
Identify Anxiety disorders
(Neurotic, Stress-related and somatoform disorders)
Post Traumatic Stress Disorders (PTSD)
1.Catastrophic trauma
2.Intrusive recollection
3.Avoidance
4.Autonomic arousal
Obsessive Compulsive Disorders (OCD)
1.Obsessions (in thoughts)
2. Compulsions (in action)
Identify Depression symptoms
1. Cognitive error
-
over generalization
maximization of negatives
minimization of positives
2. Thought process
-
irrational, illogical & unrealistic
3. Biological symptoms
-
sleep, appetite and libido affected
Bio – Psycho – Social Model
Drugs – Counselling – Support
Anil Kumar TV, Nair MKC. Medical College, Trivandrum
ADOLESCENT SUBSTANCE USE
younger ages getting involved
Rule out Psychosis
(Serious Mental Health Disorder)
1. Hallucinations
(seeing, hearing, smelling
or feeling-touch, unreal
things/events)
2. Delusions
(unshakable false belief)
Psycho-therapy by Clinical Psychologist/psychiatrist
Mental health disorders –
Psychopharmacology in a nutshell
Disorder
Medication
Dose
Dosing
ADHD
Atomoxetine
1.2 - 1.8mg/kg
Once/twice daily
Anxiety disorder
Fluoxetine
10-40 mg
Depression
Fluoxetine
10-20 mg
Mania
Carbamazepine 100 mg BD
Once with
Breakfast
Once with
Breakfast
Twice daily
(Serum 8-12 mg/L)
Conduct disorder Carbamazepine 100 mg BD
Twice daily
(Serum 8-12 mg/L)
Psychosis
Risperidone
2 - 4mg/day
Once/ thrice
Paul Russel, Professor, Child & Adol Psychiatry, CMC, Vellore
Section. 2
Adolescent
Preventive
Services
Common Adol. Medical
Problems
Headache (significant)
Refractory Error
Urinary Tract Infection
Acne, Dandruff
Allergic rhinitis
Dysmenorrhoea (girls)
Leucorrhoea (girls)
Preventing Acne
(Avoid too much Cosmetics)
Oil Acne
Acne
Acne Excorie’e
Cystic acne
Acne - Treatment
Mild – Anticomedogenic (Topical)
Clindamycin (Clindac-A)
Adapelene (Adaclene)
Clindamycin+Adapelene (Clinmiskin A Gel)
Mod.to Sev. (Topical + Oral Antibiotics)
Doxycyclin , Erythromycin, Azithromycin
Severe (Topical + Oral Antibiotics +
Oral isotretinoin – “Isotane” (Teratogenic !!!)
Courtesy : Dr.Anuja George, Dept. of Dermatology, MCH, TVM
Severe Dandruff
Dandruff & Seborrhoea Treatment
 No permanent cure
 Regular treatment for years
 DANDRUFF – Shampoo containing;
Selenium sulfide, Zinc pyrithione,
Ketoconazole, Tar,
Terbinafine, Steroid
 Systemic steroids, Isotretinoin
Courtesy : Dr.Anuja George, Dept.of Dermatology, MCH, TVM
Dental Caries
Monitoring BMI
BMI denoted by the point joining height & weight. If it
comes in Green Zone – Normal weight, Red below –
Undernutrition, Red above-Obesity
Preventing Low Birth Weight
Baby
Assuring Good Height
‘Thelarche’
to
‘Menarche’
Crucial 2 yrs for Nutrition
Intervention
Preventing Obesity
(Healthy Eating)
Once Obese, Always Obese !!!
Preventing Lifestyle Diseases
Will Today’s Child be Tomorrow's Cardiac Patient ?
Obesity
Hypertension
Dyslipidemia
Insulin resistance
Smoking
Possibly Yes !
Most adult life style diseases have their
onset in Childhood & Adolescence
Ten Commandments for
Health and Longevity
1. No tobacco
2. No trans fat – as dalda
3. Reduce salt – pickles, pappads
4. Reduce sugar – sweets, chips
5. Reduce cholesterol – fatty food
6. Reduce stress levels
7. Reduce TV/Computer time
8. Increase physical exercise
9. Increase fruits & vegetables
10. Increase family quality time
Section. 3
Adolescent
Reproductive
Health Services
NK Arora
Puberty
Includes
1. Adolescent growth spurt
2. Development of secondary sexual characteristics
3. Attainment of fertility
4. Establishment of individual sexual identity
In girls
8-12 years
In Boys
9-14 years
Bone Growth
50% of bone growth during 1st month of life to puberty onset
30% in puberty
20% in late adolescent to adulthood
Thus total bone growth during adolescence=50%
Genitourinary Problems
Delayed Puberty
In Boys
Lack of pubertal
In Girls
 Lack of secondary
sexual characteristics
changes by the age of
by the age of 13 years.
14 years
Absence of
menarche by the age
of 16 years or 5 years
after the onset of onset
of puberty.
Good Menstrual Hygiene
Practice
Good personal hygiene give self confidence.
Do not use chemical disinfectants there
Before onset of flow it may be comfortable to
trim the hair around genitalia
Shaving may lead to folliculitis
Use neat, dry napkins/clothes
Wash genitals before bed
Folliculitis
Endometriosis cause of severe
menstrual pain & Infertility
Chocolate Cyst
Tab. Mefenamic Acid (Meftal Spas) 250mg – 3 times
Genito-Urinary Infections
Long (M), Short (F) Urethra
Urinary infections &
Kidney Scar
Reproductive Tract Infections
Candidiasis
Curdy white discharge, intense vulval itching
(Tab.Fluconazole 150mg single doze
Tab. Onecan, Norcan, AF 150, etc..)
Bacterial Vaginosis
Grayish discharge with fishy odor
Tab. Metronidazole 400mg tds for 7 days
or 2gm single dose
Trichomoniasis
Candida albicans
Gardnerella
Vaginalis
Frothy greenish, foul smelling discharge
Tab. Metronidazole 200mg tds for 7 days
or 2gm single dose
NACO Guideline 2007
Trichomonas
vaginalis
Pelvic Inflammatory Disease
Tubo-ovarian abscess
PID: COMPLICATIONS
Adhesions
Pelvic abscess
Scarred or blocked fallopian tube /
possible infertility
Poly Cystic Ovary Disease
(PCOD)
Obesity
Acanthosis Nigricans
Midline hirsutism
Multiple cysts
PCOD (contd…)
Management
Obesity (80%) : Even 5% weight loss cause resumption of
menses and lower androgen levels.
Irregular period : Estrogen - Progesterone Pill (Novelon)
regularizes periods & combats mild hirsutism
Hirsuitism/Acne/Seborrhea: Oral Contraceptive (Ethinyl
estradiol) with Antiandrogen (Cyproterone acetate 2mg)
for 6 -12 cycles only at a time (Diane 35 or Ginnette)
Acanthosis Nigricans: Insulin Sensitizing Agents
(Metformin 1gm daily), helps the body utilize insulin
more efficiently by effects on glucose metabolism
Teenage Pregnancy
Risk factors for pregnancy among
unmarried Adols & Young Adults
1. Lack of appropriate parental control
2. Poor Intra family relationship
3. Lack of SRH knowledge
4. Problem Family
5. Lack of engagement in activity
6. Lack of knowledge on STI
Sheelamoni.A, MKC Nair. Ph.D Thesis, 2008
Sexual abuse
Self reported sexual abuse among youth (15 – 24 yrs)
UNFPA-CDC-DHS-CDC ARSH Study findings (n=4225)
Girls = 10.2%
Boys = 05.2%
Oath
“I am the custodian of my mind, body & spirit
– I will protect, preserve & enhance it”
Sexually Transmitted Infections
lead to Infertility
Chlamydia Trachomatis
Sexually Transmitted Infections
lead to Infertility
Genital Herpes
Human Pappiloma Virus
Infections lead to Cancer cervix
Family Life Education - <18 years
Nutrition Education
Repro.& Sexual Growth
Personal hygiene
Scholastic counselling
Risk taking behaviour
HIV & Substance abuse
Life skill education
Sexuality Education 18 yrs & above
(Priorities change as we grow)
Physical (orgasm) -Biological need
Legal
-Safety & Security
Romantic
Adolescence
-Love & Belonging
Social/Cultural
-Acceptance
Aesthetic
-Self-esteem
Emotional(Ecstasy)-Caring & affection
Young Adults
Existential
-Self awareness
Psychological
-Self-actualization
Spiritual(Fulfillment)- Trancedence
Later Family Life
Pre-marital Counselling for
Good Family Life
The physical
to enjoy beauty is not a sin
The mental
giving type” – panacea for success
The spiritual
do not hurt someone if possible & do
not hurt yourself ever
THANK YOU