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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.
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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 area- three 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
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
Environment Intelligence Poor fit Mental illness Subject problem Scholastic Backwardness Correctly Evaluate Poor Performance Poor school performance These students need special help 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
Conation (behaviour) Affect (feeling) Cognition (thinking) B – Behaviour A-Antecedents C – Consequence Counseling – ABC Analysis
Adolescent Mental Health Disorders1. 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 Disorders2. 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 Disorders3. 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 IssuesSymptoms to Disorder Transition • Symptoms out of proportion to cause • Definite bodily symptoms present • 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 • 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 ModelDrugs – Counselling – Support Anil Kumar TV, Nair MKC. Medical College, Trivandrum
Rule out Psychosis(Serious Mental Health Disorder) • 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 Paul Russel, Professor, Child & Adol Psychiatry, CMC, Vellore
Section. 2 Adolescent Preventive Services
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
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
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)
Most adult life style diseases have their onset in Childhood & Adolescence Preventing Lifestyle Diseases Will Today’s Child be Tomorrow's Cardiac Patient ? Possibly Yes ! Obesity Hypertension Dyslipidemia Insulin resistance Smoking
Ten Commandments for Health and Longevity • No tobacco • No trans fat – as dalda • Reduce salt – pickles, pappads • Reduce sugar – sweets, chips • Reduce cholesterol – fatty food • Reduce stress levels • Reduce TV/Computer time • Increase physical exercise • Increase fruits & vegetables • Increase family quality time
NK Arora Section. 3 Adolescent Reproductive Health Services
Puberty • Includes • Adolescent growth spurt • Development of secondary sexual characteristics • Attainment of fertility • Establishment of individual sexual identity • In girlsIn Boys • 8-12 years 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 Girls • Lack of secondary sexual characteristics by the age of 13 years. • Absence of menarche by the age of 16 years or 5 years after the onset of onset of puberty. In Boys Lack of pubertal changes by the age of 14 years
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
Reproductive Tract Infections Candidiasis Curdy white discharge, intense vulval itching (Tab.Fluconazole 150mg single doze Tab. Onecan, Norcan, AF 150, etc..) Candida albicans Bacterial Vaginosis Grayish discharge with fishy odor Tab. Metronidazole 400mg tds for 7 days or 2gm single dose Gardnerella Vaginalis Trichomoniasis Frothy greenish, foul smelling discharge Tab. Metronidazole 200mg tds for 7 days or 2gm single dose Trichomonas vaginalis NACO Guideline 2007