SETTING UP ADOLESCENT HEALTH CARE SERVICES
Dr. Kaustav Nayek *, Dr. Kaberi Basu **, Dr. Sukanta Chatterjee MD (Cal) ***
Prof. & Head, Dept. of Pediatrics, Calcutta Medical College, In-Charge, Adolescent Health Clinic Kolkata*, Prof. & Head, Dept. of Pediatrics, Calcutta Medical College, In-Charge, Adolescent Health Clinic Kolkata**, Prof. & Head, Dept. of Pediatrics, Calcutta Medical College, In-Charge, Adolescent Health Clinic Kolkata ***
WHO defines between 10-19 years of age with early (10-13 yrs), mid (14-16 yrs) and late adolescence (17-19 yrs) subgroups. More than 22% of population are in adolescent age group. In that sense more than 23 crores of Indians are. Imagine the huge population. Fortunately medical ailments are less common in this age group but there is every possibility of late detection of adolescent problems because feel shy to report, they are often confused - what is normal and what is not; whether the bodily or mental changes he/she is having are abnormal and need reporting. Even when repot to their parents, they feel it could be puberty changes and take a causal 'wait & watch' attitude. When the parents look for the medical help, most of the time they don't understand to whom they should go for it, Pediatricians usually take care of the children up to 12 years of age and the physicians feel comfortable to deal with adults, i.e., over 18 years of age. Therefore adolescent problems are not properly addressed and what we see ultimately is far less than the real magnitude of the problem.

In spite of commitment of IAP to take care of, Pediatricians are not well oriented professionally to identify and treat the rapidly changing physical and mental state abnormality. For working doctors there are no 'adolescent clinic, OPD or indoor' to gather in service experience. Similarly incoming professionals (students) are not having any adolescent chapter in the text book or classes or clinics in their curriculum. Therefore adolescent clinic is essential to offer service to the and also for orientation of the professionals. To start with, it is better to have OPD/clinics, before indoor services for this age group could be separately established.

If it is decided to provide health care services for these population - where to get them? Since this is a new field of healthcare system, it may be difficult to get the beneficiaries to the clinic in the early stage. The unique negative health seeking behavior of the are equally responsible. To establish contacts with , the help of the educational institutes, health establishments, social occasions like cultural and sports activities, medias and clubs / NGO's for non-goers, are very much essential. A strong 'advocacy group' consisting of dignitaries in different sectors of society must be developed, who will pled for the need of such an important field of medicine.
Sensitization of Teachers and Parents
Teachers should be approached through authority. Group-discussion with teachers must be held about normal adolescent health with its deviations. A 'participatory' approach is better than giving 'lectures'. Teachers are allowed to talk about their experiences regarding their adolescent students. Teachers are developed as -counselor. Through teachers, parents are called in for group meeting at and in the same way the parents are made aware of adolescent - health issues and their problems, definitely with participatory approach.

Thereafter are approached for health guidance in the classrooms and are asked to fill up the 'questionnaire' based. Format of Adolescent Preventive Service (FAPS). This FAPS questionnaire will identify health risk behavior in before they can lead to disease. This screening could be done by the teachers using computer software, since all secondary and higher secondary s are having computers nowadays. If an adolescent is identified as having high risk factors in FAPS screening, they will be referred to 'Adolescent Clinic'. The first visit could be along with their parents but for subsequent visits they can choose to come alone. This can be done once a year and will cover the huge going adolescent population with minimal health professionals.

Anyone can come to clinic directly or with reference. It must be one window service for all from 10-19 years i.e., age specific clinic.
Personals
  • Main pivot is Pediatrician
  • Others professional - psychologist, psychiatrists, gynecologist, endocrinologist etc.
Timings
May be once a week to start with, preferably second half of the day or Saturday to get hours over.
Reception
The 'waiting hall' and the 'receptionist' - both should be adolescent friendly including the doctor himself/herself.
Adolescent Friendly Way
  • Consent of adolescent and parents for interview and examination.
  • Confidential care - both parents and adolescent should be told clearly that whatever information the attending term will get from them will be kept confidential, unless the doctor feels that it is necessary to discuss with the parents for the interest of the adolescent. In that case too, the doctor should negotiate to get the consent of the adolescent.
  • Privacy in examination is essential.
  • The doctor should not be in a hurry, usually it takes 30-40 minutes for completing the interview in the first visit health care provider must be non-judgmental. If an adolescent opens a problem, he can discuss different options in solving that and help the adolescent to choose the solution.
  • Allow to talk freely and openly.
  • Slow that you care for their feelings
  • Show respect to adolescent individual.
  • Ambience of the clinic including toilet and waiting space - good.
  • Exit comment box in the clinic for feedback.
  • Keep out-of-the clinic communication facilities e.g., Telephone, e-mail.
Examination
Adolescent girl is better examined in front of her mother. SMR and gynaecological examination may be done latter. Besides general examination, record of height, weight, Blood pressure to be taken. Evaluation for presence of 'anemia' and any other systemic disease is to be done.

All should have annual health guidance to promote better:
  • Understanding of physical growth
  • Psychological and psychosexual development
  • Prevention of injuries
  • Benefit of regular physical exercise
  • Understanding about healthy diet and benefits of healthy dietary habits
  • Safe weight management
  • Avoidance of tobacco, alcohol and drugs
  • Sex education, group counseling and parental involvement

All should be asked annually for:
  • Use of tobacco, alcohol, drugs and substance abuse
  • Involvement in sexual behavior
  • Behavior indicating depression, suicide attempts
  • Emotional, physical or sexual abuse
  • Learning problems or problems

All should be screened/examined annually:
  • Routine clinical examination
  • Growth monitoring - height, weight
  • Blood pressure, anemia
  • Tuberculosis, parasitic infestation

Slogan : Let Adolescent Clinic grow in number and quality.
Clinical Activities
Methods Age of
Early adolescent Middle adolescent Late adolescent
10,11, 12, 13 yrs 14, 15, 16 yrs 17, 18,19 yrs
Parents guidance        +         +         +
Screening by history (FAPS)   +    +    +    +   +    +    +       +          +
Test & Immunization   +    +    +    +   +    +    +       +          +
 
As and when necessary / recommended
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Nayek K D, Basu K D, (Cal) M C S D.. Available From : http://www.pediatriconcall.com/fordoctor/ Conference_abstracts/report.aspx?reportid=65
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