RESPONDING TO

THE ADOLESCENT
ADOLESCENT HEALTH CARE FOR PRIMARY SERVICE
PROVIDERS

Foundational Course Module 2

MODULE 2 SESSION 1

HEEADSSS
Module 2: Responding to the Adolescent 2
 Learning Objective

Discuss HEEADSSS tool being used to

identify protective factors and to detect
risks in adolescents’ social, educational
and home environment.

Module 2: Responding to the Adolescent 3 of 46

 ACTIVITY 1.01

Screening Tool
Module 2: Responding to the Adolescent 4
 Screening Tool
Home
Education and Employment
Eating and Exercise
Activities and Peer Relationships
Drug Use/Cigarettes/Alcohol
Sexuality
Suicide and Depression
Safety
Module 2: Responding to the Adolescent
• A screening tool for conducting
a comprehensive psychosocial
and health risk assessment
• Provides and ideal format for a
preventive health check.
• Provides information about
young person’s function in key
areas of their life
5
 Rapid HEEADSSS Form
• Psychosocial triaging
• Self-administered questionnaire
• To increase the uptake of psychosocial screening for early
identification of risk-factors to prevent unfavorable health
outcomes
• Not a replacement to the comprehensive psychosocial assessment
(HEEADSSS)

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Self-Administered
Rapid
HEEADSSS Form

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 Using the Rapid HEEADSSS
Two-way referral
Psychosocial Evaluation Interventions
(Guidance counselor/ psychologist,

Yes school nurse, guidance designate,

homeroom teacher)

Fill-out the YES to any items

Intake Process Immediate CHIILD PROTECTION
SCHOOL questionnaire concerning safety
- Homeroom - Fill-out

Parental Notification
- Enrollment registration sheet - Provide audio- Assess
- Provide short Yes Preventive
- Annual PE visual privacy need
orientation on the Psychosocial counseling,
- throughout - Issue the tear- for YES to any
process Within the next month concerns Health education
the school urgent other items
- Discuss privacy away section session/s
year - Submit form evalua
and confidentiality tion
- Assign a control directly No
number/ student NO to all Within the school Physical health
number items year Concerns

Homeroom Adviser

ARH Coordinator
Guidance Counselor/ Designate
School Health & Nutrition Personnel
 External Referral
Two-way referral
Health-related Referral
(Secure referral form)
Primary

Internal referral
Secondary
Primary
Private facilities/ specialized care

Notification
Parental
Non-Health-related Referral
(Secure referral form)

Barangay/SK
DSWD

PNP

CSO/NGO
Others

ARH Coordinator

Receiving Agency 9
 Using the Rapid HEEADSSSCOMPREHENSIVE HEEADSSS/
Full Psychosocial Interview
YES to any
items
Immediate
concerning
safety

REFERRAL
Assess
Fill-out the need for YES to any Within the next
questionnaire urgent other items month
evaluation

Within the school

NO to all items
year

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ACTIVITY 1.02

Interview Protocol
Module 2: Responding to the Adolescent 11
 Interview Flow

Introduction Interview Proper Summary

• Describe the set-up • Information gathering • Issues
• Discuss Confidentiality • Addressing the issues
• Ask the • Plans
parent/guardian to
step out

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TIPS: Prepare as an interviewer
• Be yourself
• Be approachable
• Be good listener
• Be professional
• Be caring
• Exhibit non-judgmental attitude
TIPS to engage adolescents
o Liking the adolescent
o Involving the family
o Establishing rapport
o Ensuring confidentiality
o Acting as an advocate
o Listening and displaying interest
o Discovering the hidden agenda
o Use a developmentally oriented
approach
 TIPS to establish rapport
• Introduce yourself
• Direct questions to the adolescent
• Talk about their interest
• Treat their concerns seriously
• Explore issues that concern the teen -
not only the concern of the parents
Ensuring Confidentiality

◊ Discuss limits of confidentiality: abuse,

harm to self or others, breaking the
law
◊ Parents and teens should be made
aware of confidentiality guidelines
◊ Strong determinant for health seeking
behavior of adolescents
 Interview Flow

Introduction Interview Proper Summary

• Describe the set-up • Information gathering • Issues
• Discuss Confidentiality • Addressing the issues
• Ask the • Plans
parent/guardian to
step out

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Strengths-Focused
• Strengths based questions seek to
identify young people’s strengths
• Use open ended questions, asking for
descriptions, “how come” rather than
“why”.
• Practice using open ended questions
throughout the HEEADSSS interview
• Opportunity to work with the
adolescent to maximize their strengths
and mitigate risks
 HEEADSSS

Home Home Situation, Family Life, Relationship and Stability

Education/ Explore sense of belonging at school/work and

relationship with teachers/peers/workmates/changes in
Employment performance

Explore how they look after themselves; eating

Eating and Exercise and sleeping patterns

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 HEEADSSS

Activities and Peer Explore social and interpersonal relationships, risk taking
Partnerships behavior and attitudes about themselves

Drug
Explore context of substance use (if any) and risk taking
Use/Cigarette/ behavior
Alcohol
Explore their knowledge, understanding, experience,
Sexuality sexual orientation and sexual practices - Look for risk
taking behavior/abuse

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 HEEADSSS

Suicide/Self Harm/ Explore risk of mental health problems, strategies for coping and
Depression/Mood available support

Explore history of accidents, physical or sexual abuse or bullying;

Safety/Spirituality violence in home, school or neighborhood; belief system, religion
and faith

Module 2: Responding to the Adolescent 21 of 46

 Interview Flow

Introduction Interview Proper Summary

• Describe the set-up • Information gathering • Issues
• Discuss Confidentiality • Addressing the issues
• Ask the • Plans
parent/guardian to
step out

Module 2: Responding to the Adolescent 22 of 46

 Appropriate Interview Practice

Video
DOH ADEPT Module 2 Appropriate Practice

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 BREAKOUT SESSION

HEEADSSS
MODULE 2 SESSION 1:

Module 2: Responding to the Adolescent 24

 Breakout Room Mechanics
• The participants will be assigned to 4 breakout rooms
• An adolescent guest will be joining each group
• The group will conduct a MOCK INTERVIEW
‐ Each adolescent guest was given a (fictional) case to portray
‐ The case will not be disclosed to the participants, except for the age
‐ The case will unfold during a psychosocial interview to be conducted by the
participants
‐ This set-up is for the purpose of demonstration, psychosocial interviews are
best conducted one-on-one
‐ The group is allotted 45 minutes for this run

Module 2: Responding to the Adolescent

 Conducting the HEEADSSS Interview
• The adolescent, interviewer and facilitators will keep their cameras
open
• Parents are already informed and out of the room
• Rapport building will only be for the first person assigned
• Each assigned person will only ask 3 questions
• Participants should be able to connect to questions and relate it to
the next section of HEEADSSS
• Summary of findings shall be discussed to the adolescent

Module 2: Responding to the Adolescent

 Role Assignments
INTERVIEW PARTICIPANT
Introduction/Discussion of confidentiality and its
limits
Home
Education and Employment
Eating Behavior and Exercise
Activities and Peer Partnerships
Drugs and other Substances
Sexuality
Suicide, Self-harm, depression, mood
Safety, Spirituality
Summary of findings and plans

Module 2: Responding to the Adolescent

INTERVIEW PROPER
HEEADSSS
Module 2: Responding to the Adolescent
 PROCESSING

FOR OUR ADOLESCENT LEARNER

1. How did you feel about the

interview?
2. Do you think, this interview can help
teens?
3. Any lessons learned?
Module 2: Responding to the Adolescent
 PROCESSING

FOR OUR PARTICIPANTS

For the interviewer, how did you feel about

doing the interview?

Module 2: Responding to the Adolescent

 PROCESSING

FOR OUR PARTICIPANTS

1. What are your realizations about the teenagers?

2. What did you find easy during the interview process?
3. What was difficult during the interview process?
4. What could you have done better?

Module 2: Responding to the Adolescent

 Take Home Messages

To overcome the difficulties

Conduct of Improving our skills in
and to make the interview
interviewing is not just
psychosocial screening through this activity,
process more comfortable
should be ROUTINE for the adolescent and the
PRACTICE is key
interviewer PRACTICE is KEY

The psychosocial screening

is NOT FAULT FINDING, it is
an opportunity to highlight Exercise being
their strengths and identify the NON-JUDGMENTAL
risks so we can minimize the
possible health risks
Module 2: Responding to the Adolescent
Privacy, Confidentiality,
Informed Consent
Module 2: Responding to the Adolescent 33
 Definitions
• Privacy is “the right and power to control the information (about
oneself) that others possess” (WHO 2000b). Privacy also commonly
refers to respecting the rights of individuals not to be physically
exposed against their will.
• Confidentiality is “the duty of those who receive private information
not to disclose it without the patient’s consent” (WHO 2000).
• Informed Consent is usually in the form of a document signed by the
clients, relays all pertinent and relevant services, such as risks and
benefits, to the potential clients, allowing him or her to make an
informed decision regarding participation.

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 Ensuring Privacy

• Does the clinic have enough private space?

• Can patients be seen or heard from outside
consultation rooms?
• Do staff members protect adolescents’ right to privacy
in practice?
• Do adolescents have the opportunity to see health
workers without parents, family, partners, or friends?

Module 2: Responding to the Adolescent 35 of 46

 Private Space
• For providers to consult with adolescents
individually?
• For information about the adolescent collected in a
private room rather than the reception area?
• Review and use available space more efficiently (e.g.
clearing out “dead space” or storage space
• Adjust patient flow, wherein collecting information
is transferred from a receptionist to a different
provider
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 Sound of Silence
• Are the walls and doors of
consultation rooms solid
enough to prevent
adolescents from being seen
or overheard from outside the
consultation room, such as
hallways, adjoining rooms or
reception areas?
• Are curtains used to separate
any consultation areas?
Module 2: Responding to the Adolescent
• Ideal scenario: strengthen walls
and doors of consultation room.
• Second best: Use curtains to
separate consultation areas.
• Speak softly.
• Ask colleagues to vacate the
room
• Develop policies re sensitive
information are private
37
 Staff Members
• Do receptionists or any personnel
at the receiving area ask
adolescents to state the reason
for their visit in front of other
patients in the reception area?
• Do staff members collect intake
information in the waiting room?
• Do staff members routinely
interrupt or walk in on
consultations or counselling
sessions
Module 2: Responding to the Adolescent
• Ensure no one else is around
when taking personal
information from the patient.
• Have staff understand that the
breech of privacy and
confidentiality puts the
adolescent health and safety at
risk.
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 No “Bring Parents”
Do/are providers or health workers:
- know creative strategies for getting a moment alone with adolescents to
ask whether she/he would like to discuss anything without the parents,
family members or friend present?
- ask adolescents about sex, sexuality, or violence in the presence of
partners, parents, family members or friends?
- aware that the person who accompanies the adolescent may reveal
information to other people or to perpetrator of violence for example?
- know how to distract a family member or friend long enough to ask an
adolescent about abuse when they suspect that the adolescent has been a
victim of violence or any related sexual and reproductive health concerns?
Module 2: Responding to the Adolescent 39 of 46
 Confidentiality

• Are medical records secure?

• Are there policies and procedures ensuring
confidentiality?
• Are the staff trained in the policies and
procedures? Do they have the basic
knowledge and awareness of the importance
of confidentiality?
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 Policies and Procedures
• When, how and why staff are allowed to share information with:
‐ Other staff members?
‐ Parents of minors / family members?
‐ Local law enforcement authorities?

• When and how staff should obtain consent from adolescents

before sharing information about her situation to a third party?
• Informing adolescents about any limits to confidentiality?

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 Staff Training
• Does the staff understand why a breach of confidentiality can put an
adolescent at great risk?
• Are the staffs trained not to reveal client information without
permission?
• Does the staff know what kinds of information, if any, it is legally
required to report to the authorities, for example, evidence of physical
or sexual abuse of adolescents, or physical violence against girls, boys, or
LGBT?
• Does the staff know how to handle HIV counselling and testing?
• Is there a mechanism in the health center for getting feedback from staff
about how well the health center policies are working?
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 SYNTHESIS

•Trust
•Privacy
•Confidentiality
•Informed Consent

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 A Case Study

Video
Module 3B Appropriate

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MODULE 2 SESSION 4

Advising Parents with Adolescent

Module 2: Responding to the Adolescent 45
 Parenting Adolescents
(Tips for Parents with Adolescent Children)

Jacqueline Kitong, MD, MPH

Technical Officer for RMNCAH-Nutrition
Office of the WHO Representative in the Philippines
During adolescence, kids need their parents
more than ever.
• Research shows that a positive family environment including fun
family activities:
‐ opens parent-child communication
‐ Encourages adolescents to participate in positive extracurricular and
community activities,

Because of such:
‐ teens are able to navigate these years with relative ease.
There is no doubt that for most families,
the teen years present a challenge for
both parents and children.
• Understand that the child has grown
up and respect the right to have an
opinion different than yours

• Be extremely friendly with them to

be able to understand them better

• Be a Facebook contact of your child

• Consult a psychiatrist (as needed)

• Encourage the entrepreneur quality
of your child ( nurture the
entrepreneur quality in the child,
giving room for exploratory “do-it-
yourself behaviors”)

• Provide career guidance

• Meet your child’s monetary needs

• Address habits and vices

• Facilitate building of their esteem

and self-confidence

• COMMUNICATE WITH THEM

 Communicate about their

infatuations and relationships
http://hrweb.mit.edu/worklife/raising-teens/five-basics.html
Good luck to all in your parenting!