SAVE THE GIRL CHILD ADOLESCENT CARE

1. 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

2. 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

3. 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

4. Resource slides

5. 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

6. Adolescent Friendly Services Key words • Accessible • Acceptable • Comprehensive • Equitable • Friendly staff

7. Section. 1 Adolescent Counselling Services

8. 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

9. Common Psychological Problems

10. 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

11. 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)

12. Adolescent Counselling - Spectrum • Advice – Not acceptable to adols • Guidance – Eg. career guidance • Negotiation – Marriage counselling!!! • Counselling – Improve personal growth • Psycho therapy – Subconscious issues

13. 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

14. Conation (behaviour) Affect (feeling) Cognition (thinking) B – Behaviour A-Antecedents C – Consequence Counseling – ABC Analysis

15. 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’

16. 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

17. 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

18. BASICs for evaluating an Adolescent! Behaviour Affect /Emotions Somatic symptoms Interpersonal relationships Cognition (thinking)

19. Oppositional Defiant Disorder  Conduct Disorder  Juvenile Delinquency 1.Dissocial 2.Defiant 3. Aggressive

20. 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

21. 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)

22. 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

23. Bio – Psycho – Social ModelDrugs – Counselling – Support Anil Kumar TV, Nair MKC. Medical College, Trivandrum

24. ADOLESCENT SUBSTANCE USEyounger ages getting involved

25. 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

26. Mental health disorders – Psychopharmacology in a nutshell Paul Russel, Professor, Child & Adol Psychiatry, CMC, Vellore

27. Section. 2 Adolescent Preventive Services

30. Common Adol. Medical Problems

31. Preventing Acne (Avoid too much Cosmetics)

32. Oil Acne Acne Acne Excorie’e Cystic acne

33. 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

34. Severe Dandruff

35. 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

36. Dental Caries

37. Monitoring BMI BMI denoted by the point joining height & weight. If it comes in Green Zone – Normal weight, Red below – Undernutrition, Red above-Obesity

38. Preventing Low Birth Weight Baby Assuring Good Height ‘Thelarche’ to ‘Menarche’ Crucial 2 yrs for Nutrition Intervention

39. Preventing Obesity (Healthy Eating)

40. Once Obese, Always Obese !!!

41. 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

42. 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

43. NK Arora Section. 3 Adolescent Reproductive Health Services

44. 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%

45. 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

46. 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

47. Endometriosis cause of severe menstrual pain & Infertility Chocolate Cyst Tab. Mefenamic Acid (Meftal Spas) 250mg – 3 times

48. Genito-Urinary InfectionsLong (M), Short (F) Urethra

49. Urinary infections & Kidney Scar

50. 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