Facilitator's guide anm_lhv

facilitator's
guide
training module for
ANMs/LHVs

for ANMs/LHVs
to provide
Adolescent-Friendly Health Services
FACILITATOR'S GUIDE
ORIENTATION PROGRAMME

Orientation Programme for ANMs/LHVs
Module I Introductory Module
Session 1 Getting to Know Each Other 30 mins
Session 2 Programme Objectives andAgenda 30 mins
Session 3 Pre-test 30 mins
Module II Adolescent Growth and Development
Session 1 Module Introduction 10 mins
Session 2 Adolescence – a Period of Change 40 mins
Session 3 Looking Back on my OwnAdolescence 30 mins
Session 4 Why Invest inAdolescent Health and Development 30 mins
Session 5 Module Summary 10 mins
Module III Dealing with the Adolescent Client
Session 2 Communication and Counselling Skills
Module IV Adolescent-Friendly Health Services 2 hr 30 mins
Session 1 Introduction and Health Services forAdolescents 40 mins
Session 2 Making ServicesAdolescent Friendly 1 hr 10 mins
Session 3 Adolescent-Friendly Clinic/ Teen Clinic 20 mins
Module V Sexual and Reproductive Health Concerns 3 hrs
of Adolescent Boys & Girls
Session 1 Module Introduction and Sexual and Reproductive 1 hr 15 mins
Health Concerns ofAdolescent Boys & Girls
Session 2 Menstruation, Male Reproductive Functions & Masturbation 1 hr 30 mins
Module VI Nutritional needs of Adolescents and Anaemia 3 hrs
Session 1 Introduction and Growth & Nutrition in 2 hrs 50 mins
Adolescents,Anaemia
Module VII Pregnancy & Unsafe Abortions in Adolescents 3 hrs 30 mins
Session 2 Magnitude ofAdolescent Pregnancies and Contributing Factors 40 mins
Session 3 Complications of Pregnancy andAbortions inAdolescents 1 hr 30 mins
Session 4 Reorganising Services to prevent and manage 60 mins
Adolescent Pregnancies
CONTENTS
2 hrs
1 hrs 30 mins
1 hrs 30 mins
2 hrs

Module VIII Contraception for Adolescents
Session 1 Module Introduction and Eligibility and 50 mins
Effectiveness of Contraceptives
Session 2 HelpingAdolescents Make well-informed and Voluntary Choice 30 mins
Module IX RTIs, STIs and HIV/AIDS in Adolescents
Session 2 RTIs and STIs inAdolescents
Session 3 Management of RTIs/STIs inAdolescents 45 mins
Session 4 HIV/AIDS inAdolescents 60 mins
Module XII Concluding Module 1 hr 30 mins
Session 1 Post-test 30 mins
Session 2 What will I do to make my health centre Adolescent 50 mins
Friendly
Session 3 Closing of the Orientation Programme 10 mins
1 hrs 30 mins
Module X NCDs, Injuries, Aggession and Violence 1 hrs 15 mins
Module XI Mental Health in Adolescents 4 hrs
3 hrs
60 mins
Session 1 Module Introduction and Importance of NCDs 15 mins
Session 2 Risk, risk taking behaviors and health risk behavior 15 mins
Session 3 Identification of risk factors and prevention of injuries,
violence and abuse
45 mins
Session 2 Mental Health and adolescents 60 mins
Session 3 Mental Illness 50 mins
Session 4 Attitudes towards Mental Health 30 mins
Session 5 Respondin to adolescents with Mental Health Problem 30 mins
Session 6 Promoting Mental Health in adolescents 20 mins

Facilitator's
Notes
OrientaOrientaOrientaOrientaOrientationtiontiontiontion
PrPrPrPrProoooogggggrrrrrammeammeammeammeamme
CONTENTS
1. Background and Objectives of the Orientation
Programme
2. Components of the Orientation Package
3. Introduction to the Facilitator's Guide
4. Schedule of Orientation Programme
5. Methodology
6. Evaluation methods for Orientation Programme

ii Facilitator's Guide for ANMs/LHVs Orientation
BacBacBacBacBackgkgkgkgkgrrrrround and Objectiound and Objectiound and Objectiound and Objectiound and Objectivvvvves ofes ofes ofes ofes of thethethethethe
Orientation ProgrammeOrientation ProgrammeOrientation ProgrammeOrientation ProgrammeOrientation Programme
Facilitator's Notes
Profile of Adolescents in India
·Adolescents comprise a sizeable population - there are 243 million
adolescents comprising nearly one-fifth of the total population (21.4%).
·Early marriage is common - 47% of Indian women were married before they
attained the age of 18 years (NFHS 3). While the average age at marriage for
educationally disadvantaged female is 15 years, for women who have
completed school it is 22 years. It indicates that continuation of education
results in delayed marriage.
·Maternal mortality rate due to teenage pregnancy is 9% (2007-2009) - A high
risk of pregnancy and childbirth results in a high level of female mortality in the
reproductive age group. Maternal mortality of teenage mothers is a grave
cause for concern.
·TFR amongst 15-19 yrs old is 14% in urban and 18% in rural of the total fertility
(NFHS 3).
·Unmet need for contraceptives - The contraceptive knowledge is quite high
among adolescents but there are high gaps between knowledge and usage.
Unmet need of family planning in the 15-19 age group is 27% (NFHS 3).
Neonatal, postnatal, infant and child mortality is higher than in mothers ages
<20 years as compare to age 20-24 years.
·More low birth babies by mothers age <20 years.
·Economic compulsions force many to work - Nearly one out of three
adolescents in 15-19 years is working.
·More than 33% of the diseases burden and almost 60% of premature deaths
among adults can be associated with behaviors or conditions that began or
occurred during adolescence for ego Tobacco, alcohol use, poor eating habits,
sexual abuse and risky sex (WHO 2002).
·Crimes against adolescents are prevalent - Sexual abuse of both boys and
girls cuts across economic and social classes. According to a survey, in 84 %
cases, the victims knew the offenders and 32 % of the offenders were
neighbours. Crimes against girls range from eve teasing to abduction, rape,
prostitution and violence to sexual harassment. Unfortunately, social taboos
prevent these crimes from being registered. Even when registered,
prosecution rarely takes place.
·Trafficking and Prostitution has increased - Extreme poverty, low status of
women, lax border checks and the collision of law enforcement officials has
lead to increase in prostitution. Expansion of trafficking and clandestine
movement of young girls has also increased across national and international
borders.
·Misconceptions about HIV/AIDS are widespread - There is a high level of
awareness about HIV among young people especially among those who are
more literate.As per (NFHS 3) awareness of STls' and HIV/AIDS was limited in
15-24 yrs age group. Young men and 15% of young women reported
awareness of STI.

iiiFacilitator's Guide for ANMs/LHVs Orientation
Use of services by adolescents is limited. Poor knowledge and lack of awareness
are the main underlying factors. Service provision for adolescents is influenced by
many factors. For example, at the level of the health system, lack of adequate
privacy and confidentiality and judgmental attitudes of service providers, who often
lack counseling skills, are barriers that limit access to services. Shortcomings in
their professional training often result in service providers being unable and sometimes
unwilling to deal with adolescents in an effective and sensitive manner.
To address this need, the ‘Orientation Programme for Medical Officers, ANMs &
LHVs and Program Managers' has been developed to enhance skills of service
providers to deliver adolescent-friendly reproductive and sexual health services.
Overall Objective
The overall objective is to orientANMs/LHVs to the special needs and concerns of
adolescent boys and girls and to design appropriate approaches to address these.
This will strengthen the abilities of health-service providers to be able to respond to
adolescents needs more effectively and with greater sensitivity. It is expected that
this Orientation Programme will significantly contribute to building capacity on
adolescent health and development issues.
Intended Beneficiaries
The Orientation Programme is intended for health-service providers (Medical Officers,
ANMs, LHVs and and Programme Managers) who provide preventive, promotive and
curative health services to the adolescents. This five day Orientation Programme is
forANMs and LHVs.
Expected Outcomes
It is expected thatANMs/LHVs who participate in this Programme will:
• Be more knowledgeable and aware about the characteristics of adolescence
and the various issues and concerns of adolescent health and development;
• Be more sensitive to adolescent needs and concerns;
• Be able to provide “adolescent-friendly” health services that respond to their
needs and are sensitive to their preferences;
• Be able to refer them to doctors in a timely manner.
• Design a personal plan of action indicating the changes they will make in their
personal and professional lives and their surroundings.
The orientation is not intended to equip participants with specific clinical
skills in adolescent health care.
Facilitator's Notes
It is important to influence the health seeking behaviour of adolescents as their
situation will be central in determining India’s health, mortality, morbidity and
population growth scenario. Adolescent pregnancy, excess risk of maternal and
infant mortality, reproductive tract infections, sexually transmitted infections, and
the rapidly rising incidence of HIV/AIDS in this age group are some of the public
health challenges. In context of the reduction of IMR, MMR, and TFR addressing
adolescents in the program framework will yield dividends in terms of delaying age
at marriage, reducing incidence of teenage pregnancy, prevention and
management of obstetric complications including access for early and safe
abortion services and reduction of unsafe sexual behaviour.

iv Facilitator's Guide for ANMs/LHVs Orientation
In practical terms, this orientation programme will provide participants with ideas
and practical tips to the key question:
• What do I, as anANM/LHV, need to know and do differently if the person who
walks into my health centre is aged 16 years, rather than 6 or 36?
Components of the Orientation Package
The Orientation Programme is designed to be implemented mainly in a workshop
setting. It is intended to be a dynamic and interactive programme in which facilitators
actively engage the participants in the teaching/learning process. Arange of teaching
and learning methods has been carefully selected to enable this to happen in an
effective manner.
The Orientation Package consists of two documents:
• Facilitator's Guide
• Handout
The Facilitator's Guide provides all the information and material needed to conduct
the orientation. It includes the module schedule and the “step-by-step instructions”
to conduct each of the sessions in a module. It also includes all the support materials
needed to conduct the sessions, such as flipcharts and their contents, and case-
study materials with notes on issues that may be raised during discussion. It also
includes Tips for Facilitator to help you respond to questions that may be raised by
participants, identify matters that may be sensitive and about how to deal with
them.
The Handout consists of support materials for each module and it is to be given to
each participant, so that they could refer to them at a later date.
Facilitator's Notes

vFacilitator's Guide for ANMs/LHVs Orientation
Introduction to the Facilitator Guide
Content of the Facilitator Guide
The Facilitator Guide consists of twelve core modules. It is necessary for all participants
to go through all the twelve core modules because they cover the essential topics that
will equip the participants with the knowledge and understanding they need to achieve
the overall objectives of the Programme. The facilitators will feel confident while
conducting a session if they prepare and familiarise with them a day before the
session.
Support Materials used for facilitating the Orientation
Each module consists of support materials. You will need to read carefully and
understand them, to help you conduct the orientation effectively. The Handout is a
compilation of handouts for each module. A copy of the Handout would also be
given to each participant of this Orientation Programme, for leisure reading and
better understanding of the issues.
Facilitator's Notes
Methodology
The teaching and learning methods used throughout the Orientation Programme
are participatory and appropriate to working with adults who always bring a wealth
of personal experience to any learning event. It is recognized that the main group of
intended participants already have some experience of working with adolescents
and adolescent health issues.
A participatory approach enables the individual to draw on her own experience and
learn in an active way. It also enables a more equal relationship between participants
and facilitators than is possible in more conventional trainer-learner or teacher-
student approaches.
The Programme uses a range of methods and approaches, from direct input in the
form of short mini lectures to problem-solving in small groups and role play sessions.
Ground rules for participatory learning
Experience has taught us that it is sometimes necessary to establish some ground
rules when using participatory approaches. The following are some examples of
such rules:
• Treating everyone with respect at all times, regardless of gender, age or cultural
differences;
• Ensuring and respecting confidentiality so that facilitators and participants are
able to discuss sensitive issues (such as those relating to sexual and
reproductive health, mental health and substance use) without fear of
repercussions;
• Agreeing to respect and observe time-keeping and to begin and end the sessions
on time;
• Making sure that everyone has the opportunity to be heard;
• Willing to accept and give critical feedback;
• Drawing on the expertise of other facilitators and the participants in difficult
situations.
Adherence to these rules will help to ensure an effective and enjoyable learning
environment.

vi Facilitator's Guide for ANMs/LHVs Orientation
Facilitator's Notes
Evaluation methods for Orientation
Programme
The Orientation Programme is designed to be implemented mainly in a workshop
setting. People usually enjoy participating in a workshop, particularly when they are
active participants. However, measuring what they have learned from the workshop
can be difficult. In this programme some evaluation methods have been included
that are very quick and easy to use and obtain immediate feedback. Using them
will give the following:
• Evidence of how the workshop affected the participants
• Facilitators can see where the workshop has been less effective, which means
they can try to address the reasons for that in the future
The methods included here are immediate! This means that there is no time-
consuming analysis. It also means that they act as a kind of needs assessment,
because they can reveal which topics and issues required special attention during
the modules.
Evaluation can be carried out at different levels to measure different things. In this
Orientation Programme change would be measured at three levels:
a) Participants’ reactions to the workshop
b) Changes in participants’ attitude and knowledge
c) Change in participants’ practice (expected post training)
These methods of evaluation are built into the module.
a) Evaluation method to measure par ticipants'
reactions to the workshop – The Satisfaction Meter
This is an easy way of keeping in touch with how the participants experience the
programme on a daily basis. By getting their early reaction the facilitator will be
able to make changes immediately, rather than receiving complaints at the end of
the workshop when it is too late to respond to them.
Module Satisfaction Meter
Module I Module II Module III
The Satisfaction Meter
Not-so-satisfied
Satisfied
Disappointed

viiFacilitator's Guide for ANMs/LHVs Orientation
Facilitator's Notes
As its name suggests, the Satisfaction Meter allows the facilitators to get a sense
of the group’s mood after completion of each module.
The Satisfaction Meter should be put up in an accessible location in the training
room.
Explain that the three faces indicate the following in a descending order: "satisfied",
"not satisfied" and "disappointed".
At the end of each Module, the participants are asked to mark a spot, according to
how they feel, on the Satisfaction Meter.
Draw a line through the middle of the spots to create a simple graph that charts the
“ups” and “downs” of the group.
The Satisfaction Meter can be used as a means of tracking the group’s feeling
about how the workshop is proceeding, and as a starting point for discussion.
b) Evaluation method to measure changes in
participants’ knowledge – Pre/Post test
Each participant is asked to take a simple, objective written Pre Test at the beginning
of the Programme.
The purpose of this test is a pre-training evaluation of the knowledge and attitudes
of the participants. Dispel the fear and embarrassment of participants by telling
them that it does not matter if they do not know the answers to some questions.
Their answers will help the facilitators/trainers to know their existing knowledge
regarding adolescent health and will be able to give more emphasis on the topics
with gaps in their knowledge and help modifications in attitudes during training
sessions.
At the end of the Programme, the participants take same test again. By comparing
scores of Pre and Post Tests, the facilitators know how much learning has taken
place.

viii Facilitator's Guide for ANMs/LHVs Orientation
Facilitator's Notes
c) Evaluation method to measure changes in
participants’ practice (expected post training)
After attending this Orientation Workshop it is hoped that some of what participants
learn will influence how they work in the future with adolescents. One way to support
this is to help the participants translate what they have learned into changes that
they intend to make. This should improve the chances that they will put what they
have learned into practice. Developing a personal ‘Plan ofAction’in the Concluding
Module with help participants improve their working with/for adolescents.
The Concluding Module focuses on change and leads the participants through the
process of making their personal plans to change the way they work with and for
adolescents. The process is important for two reasons. First, it helps the participant
apply what they have learned in practical ways, by enabling them to think of realistic
changes that they can make, or new things that they can do, in order to improve the
way in which they work with adolescents. It is definitely best for them to do this as
part of the training programme, with the support of the facilitators and other
participants, rather than leaving them to do it when they will be busy back at work.
Second, by making personal plans the participants provide the facilitator and
themselves with goals, against which the changes that they make may be measured.
TIPS FOR FACILITATOR
In the Facilitator Guide, you will find a section entitled "Tips
for Facilitator". These talking points have been created to give
you more information to help you to explain further the content
of the flipchart and/or activities.

Module
I
IntrIntrIntrIntrIntroductoroductoroductoroductoroductoryyyyy
ModuleModuleModuleModuleModule
Getting to Know Each Other
Programme Objectives and Agenda
Pre-test
(Total Time: 1 hrs 30 mins)
Session 2
30 mins
Session 1
30 mins
Session 3
30 mins

I-2 Facilitator's Guide for ANMs/LHVs Orientation
Objectives:
By the end of this session, participants and facilitators will be able to:
• Identify each other in the group.
• Establish rapport amongst themselves.
Activity 1
• Introduce yourself and your co-facilitator(s).
• Welcome the participants to the Orientation Workshop on adolescent health.
• Explain that before starting the programme, a few minutes will be spent on
general introductions.
• Pair the participants and facilitators.
• Put up Flipchart I -1 and ask each pair to talk to each other for 5 mins and find
out about each other (as per points written on the flipchart)
SESSION 1
Getting to Know Each OtherGetting to Know Each OtherGetting to Know Each OtherGetting to Know Each OtherGetting to Know Each Other
FLIPCHART I-1
Find out the following about your partner:
• Name
• Designation
• Place of work
• Number of years s/he has been working with
adolescents
• Ahobby
ACTIVITY TOPIC TRAINING TIME
METHODOLOGY
Activity 1 Group Introductions Introductions in 30 mins
pairs
Materials:
• Flipchart I - 1
• Name tags
• Markers
Module I
30 mins
Introduction
This module provides an introduction to the 5-day Orientation
Programme for ANMs/LHVs to provide adolescent-friendly health
services and helps acquaint the participants to one another and to the
facilitator(s). It also runs through the training objectives and
participants' expectations and sets the ground rules and norms for
the workshop.

I-3Facilitator's Guide for ANMs/LHVs Orientation
Getting to Know
Each Other
• Now ask each pair to come forward and introduce each other to the entire group.
• Keep on noting and adding up the number of years of experience of everyone in
the room as they are introduced.
• After the introductions, stress that there is a wealth of experience among the
participants present in the room. Mention the total number of years of experience
that all the participants together have in the room. Clearly there will be much
that every individual can share with and learn from others in the group.
• Then distribute the name tags and ask the participants to write clearly the
name they would like to be called during the programme - some people prefer
their first name and others their surname. Encourage them to wear the name
tags throughout the workshop.

Objectives:
By the end of this session, participants will be able to:
• List out their expections from the workshop.
• List out the objectives of the Orientation Programme.
• Have an overview of the 5-day workshop.
SESSION 2
PrPrPrPrProoooogggggrrrrramme Objectiamme Objectiamme Objectiamme Objectiamme Objectivvvvves andes andes andes andes and
AgendaAgendaAgendaAgendaAgenda
Materials:
• Flipchart I-2
• Flipchart I-3
• Flipchart I-4
• Flipchart I-5
• Blank flipcharts
Module I
30 mins
Activities Topic Training Methodology TimeACTIVITY TOPIC TRAINING TIME
METHODOLOGY
Activity 1 Listing participant Brainstorming 10 mins
expectations
Activity 2 Listing Programme Presentation 10 mins
objectives
Activity 3 Overview of the Programme Presentation 10 mins
Activity 1
• Put up Flipchart I-2, and brainstorm the participants what expectations they
have from this orientation programme.
• Note down their responses on a blank flipchart. Put up the flipchart on a wall
and let it remain there throughout the 5-days.
• Tell the group that you will refer to their expectations again at the end of the
workshop to see to what extent they were met with.
FLIPCHART I-2
• Participants' Expectations from the
Orientation Programme

Activity 2
• Show Flipchart I-3 and explain objectives of the programme.
• Stress that in this workshop emphasis is not the improvement of clinical skills,
rather it provides ability to start adolescent-friendly health services.
• Also explain:
- Why this workshop is focusing only onANMs/LHVs when many other “adults”
also influence adolescents?
- Tell them that there is a similar workshop for Medical Officers also.
- Explain that many groups including health workers, teachers, social workers,
religious leaders, and, of course, parents have important contributions to
make towards the health of adolescents.
- The Government abilities of health service providers, and so this group has
been identified as a priority, but it does not imply that other groups are less
important. You should try to involve them when you provide services to
adolescents.
Activity 3
• Give participants copies of the Handout. Ask the participants to look at the
Agenda in Handout I and briefly run through it so that they know what will be
done during each day of the Workshop.
• Explain that in the Orientation Programme particular subject modules have
been selected on the basis of health problems and health risk behaviours of
adolescents.
• Explain that the programme is tightly structured, requiring everyone’s presence
and active participation.
FLIPCHART I-3
Specific Objectives of the
Orientation Programme
By the end of this Programme, ANMs will be:
• More knowledgeable about the characteristics
of adolescent development
• More sensitive to their needs
• Better equipped with information and
resources, thereby be able to provide
adolescent-friendly health services
• Able to make a plan to indicate the changes
in their work to deliver adolescent-friendly
reproductive and sexual health services.
Programme
Objectives and
Agenda

Programme
Objectives and
Agenda
Agenda for 5-day Workshop
Day 1
Module I Introductory Module
Module II Adolescent Health and Development
Day 2
Module III Dealing with theAdolescent Client
Module IV Adolescent-Friendly Health Services
Day 3
Module V Sexual and Reproductive Health Concerns of Boys & Girls
Module VI Nutritional needs ofAdolescents andAnaemia
Day 4
Module VII Adolescent Pregnancy and UnsafeAbortions
Module VIII Contraception forAdolescent
Day 5
Module IX RTIs, STIs and HIV/AIDS inAdolescents
Module XII Concluding Module
• Inform the participants that during the workshop everyone will be asked to
share their views and perspectives with others. In this way, everyone (including
the facilitators) will be equal participants.
• Tell them that in this workshop there are NO teaching sessions; we all will learn
from each other.
• Explain what is a participatory learning process.
• Emphasise that there are some basic ground rules that would be followed
throughout the workshop.
Module X NCDs, injuries aggression and violence
Module XI Mental Health inAdolescents

Programme
Objectives and
Agenda
• Put up Flipchart I-4. Ask the participants to, formulate ground rules for the
workshop and keep writing them on a flipchart, then match with the following:
• Stress that adherence to these rules will help to ensure an effective and enjoyable
learning environment! Paste the chart on a wall so that it can then be referred to
throughout the workshop.
• Emphasise that respecting confidentiality is very important, so that facilitators
and participants are able to discuss sensitive issues (such as those relating to
sexual and reproductive health) without concern about repercussions.
• Put up the Satisfaction Meter (Flipchart I - 5) and explain it.
• Tell that throughout the Orientation Programme, it will be used to assess how
participants feel about each module.
• Place the 'Mailbox' in one corner of the room and explain that it will remain in this
location at all times so that participantsmay write down any questions related to
the Topics covered each day. They need not write their names.
Tell the participants that the questions raised will be answered by the facilitators
every day.
FLIPCHART I-5
Satisfaction Meter
Module I Module II Module III
Satisfied
Not-so-satisfied
Disappointed
FLIPCHART I-4
Ground rules for the Workshop
• Treating everyone with respect at all times,
irrespective of sex or age
• Ensuring and respecting confidentiality
• Agreeing to respect and observe time-keeping
and to begin and end the sessions on time
• Speaking one by one - Making sure that
everyone has the opportunity to be heard
• Accepting and giving critical feedback taking
care not to hurt anyone’s feelings
• Drawing on the expertise of other facilitators
and the participants in difficult situations

Programme
Objectives and
Agenda
The participatory approach to be used in the Programme could be
new to some (or many) of the participants, so it is important to
spend some time discussing it with them. Sometimes people are
resistant to what they see (visuals) because it is “a waste of time
when you (the facilitator or instructor) could simply just tell us”
the following quotation comes from about 2500 years ago- and
stresses what is an essential element of learning even today.
What I hear, I forget
What I see, I remember
What I do, I understand
Confucius (551-479 B.C)
Stress that we all learn best when we take an active part in finding
out things that are new to us!
A class in which we take part in discussions is more
interesting than a class in which we just listen to a lecture.
A class in which we can see for ourselves what things look like
and how they work, is more interesting than a class in which
we only talk about things.
A class in which we not only talk and see, but actually do and
make and discover things for ourselves, is exciting! When we
learn by finding things out for ourselves, by building on
experience we already have, we do not forget. What we learn
through active discovery becomes a part of us.
•
•
•
Remember to put up the Satisfaction Meter everyday for Modules
covered on that particular day.
The “Mailbox” is a place for the participants to record any
questions/matters arising during the course of the workshop so
that you can address them later in the workshop. Place the
Mailbox in an easily accessible place. Check mail every evening
and answer the questions next morning.

Objectives:
By the end of this session, facilitators will be able to:
• Assess the participants level of current knowledge regarding
adolescent health and development issues.
SESSION 3
Pre-testPre-testPre-testPre-testPre-test
AnneAnneAnneAnneAnnexurxurxurxurxure 1e 1e 1e 1e 1
Materials:
• Pre-test forms for
each participant
Module I
30 mins
Activity 1
• The purpose of this test is a pre-training evaluation of the knowledge and attitudes
of the participants. Dispel the fear and embarrassment of participants by telling
them that it does not matter if they do not know the answers to some questions.
Their answers will help the facilitators/trainers to know their existing knowledge
regarding adolescent health and will be able to give more emphasis on the
topics with gaps in their knowledge and help modifications in attitudes during
training sessions.
• Give each participant a pre-test form.
• Explain to the participants that they have to complete the pre-test form in 30
mins. Ask the participants to respond to the questions on their own and not
discuss them with their co-participants.
• Tell the participants that now each one of them will be given a questionnaire
related toAdolescent Health and Development. It will be a Pre-test that they
are required to take.
• Collect the answered pre-test forms from the participants after 30 mins.
• Thank the participants for filling up the pre-test.
METHODOLOGY
Activity 1 Pre-test Each Participant fills up 30 mins
a questionnaire

75%x100
20
15
=
Pre-test
•
Note: Each question is of 1 mark. If the answer is correct for
the whole question score 1 for it. In the end add up the total
marks obtained and calculate the score % by dividing marks
obtained with maximum marks 20 and multiply by 100.
Example: if a participant scores 15 marks. Her score % is
•
Answer Sheet for the pre-test form is given at the end of this
session for your reference. One of the facilitators should
correct the pre-test forms using this answered sheet and give
scores. Facilitators to note which questions most of the
participants could not answer.
The facilitators should analyze the forms during lunch time
and evening after training on the same day to identify course
areas where the participants have a gap in knowledge or
attitude and make note of it to be addressed and emphasised
during the conduction of relevant session.

Orientation Workshop for ANMs/LHVs on
Adolescent-Friendly Health Services
Pre/Post-Test
Name of State ____________________ Name of District ____________________
Name of Block ___________________ Designation _______________________
Name of Participant __________________________________________________
Dates of Programme _______________ Date ofTest ________________________
Note:Answer all questions. Multiple choice questions have only one correct answer.
Please read each question and the multiple choices carefully and put a ' P'
mark on correct answer.You may provide more information wherever asked.
1. Adolescents come under which age group?
a) 8 -10 years
b) 8 -15 years
c) 10 -19 years
d) 19 -35 years
2. What are the important changes that take place in the individual as he/she
goes through adolescence?
a) Physical
b) Mental
c) Emotional
d) All of the above
3. What are health related concerns of adolescents?
a) Menstrual problems in girls and night fall in boys
b) RTIs/STIs - Hygiene
c) Teenage pregnancy
d) Anaemia
e) Unsafe abortions
f) Drug/substance abuse/smoking
g) All of the above
4. We should invest in adolescents health because:
a) a healthy adolescent grows into a healthy adult.
b) health benefits for the adolescent's present and future.
c) economic benefits to avert future health cost.
d) Good health is adolescents' right
e) all of the above
f) none of the above
5. How do you think an adolescent feels when he/she walks into your health centre?
a) shy, embarrassed, worried, confused
b) happy and confident
Pre-test
h) Any other (please write)__________________
g) Any other (please write)___________________

6. How would you strike a rapport with an adolescent client?
a) By not asking too many questions and not making eye contact
b) By friendly, warm and non-judgmental behaviour with positive non-verbal
cues.
c) Frowning and stern behaviour.
d) None of the above.
7. Adolescents do not utilise available health services because:
a) they fear the health providers will inform their parents.
b) they are not interested.
c) they do not recognise illness.
d) they do not know where to go.
e) All of the above.
f) None of the above.
8. What are the barriers to good communication?
a) Service provider use simple words and language
b) Client feels comfortable
c) Lack of privacy
d) Adolescents are unable to talk because of fear
e) Insufficient time to explain
f) (a) and (b)
g) (c, d and e)
9. What problems are caused by lack of menstrual hygiene?
a) Anaemia, weakness, diarrhoea
b) Malaria, worm infestation
c) Vaginal discharge, burning during urination and genital itching
10. According to you, how will you rate masturbation for adolescent boys and girls.
a) Normal behaviour
b) Abnormal behaviour
c) Shameful behaviour
11. Lack of nutrition in adolescence can cause-
a) Protein - energy malnutrition
b) Stunting of growth
c) Anaemia
d) All of the above
e) None of the above
12. Night fall in boys is
a) Abnormal
b) Normal
c) Sign of serious illness
Pre-test

13. What is the risk of maternal death among women aged 15-19 years as compared
to women aged 20-35 years?
a) Lower
b) Higher
c) Equal
14. What can anANM/LHV do to prevent unsafe abortions in pregnant adolescents?
a) Counsel and refer to appropriate facility for termination of pregnancy
b) Conduct termination of pregnancy yourself
c) Scold her for getting pregnant and tell her to continue her pregnancy
now and take some contraception after delivery
15. Which contraceptive methods are appropriate for adolescents?
a) Abstinence, condoms and oral pills
b) Sterilisation, Fertility-awareness based methods and IUCDs
16. What canANMs/LHVs do to prevent STIs among adolescents?
a) Cannot do anything
b) Counsel them that abstinence, being faithful to one's partner and use
of condoms protect from STIs
c) Criticise unmarried sexually active and inform the parents of
sexually activer unmarried adolescents of their shameful behaviour
17. After unprotected sex, emergency contraceptive pills can be given to:
a) Married adolescents
b) Unmarried adolescents
c) Both
d) None of the above
18. Which services can youANM provide to adolescents?
a) __________________________________________________________
b) __________________________________________________________
c) __________________________________________________________
d) __________________________________________________________
19. What are the most important characteristics of adolescent-friendly health
facilities?
a) __________________________________________________________
b) __________________________________________________________
c) __________________________________________________________
d) __________________________________________________________
20. Which contraceptive methods are protective against pregnancy and STIs/HIV
(dual protection)?
a) __________________________________________________________
b) __________________________________________________________
Pre-test

Orientation Workshop for ANMs/LHVs on
Adolescent-Friendly Reproductive and Sexual
Health Services
Pre/Post-Test
ANSWER SHEET FOR FACILITATORS
1. Adolescents come under which age group?
a) 8 -10 years
b) 8 -15 years
c) 10 -19 years
d) 19 -35 years
2. What are the important changes that take place in the individual as he/she
goes through adolescence?
a) Physical
b) Mental
c) Emotional
d) All of the above
3. What are health related concerns of adolescents?
a) Menstrual problems in girls and night fall in boys
b) RTIs/STIs - Hygiene
c) Teenage pregnancy
d) Anaemia
e) Unsafe abortions
f) Drug/substance abuse/smoking
g) All of the above
h) None of the above
4. We should invest in adolescents health because:
a) a healthy adoelscent grows into a healthy adult.
b) health benefits for the adolescent's present and future.
c) to avert future health cost.
d) Good health is adolescents' right
e) all of the above
f) none of the above
5. How do you think an adolescent feels when he/she walks into your health centre?
a) shy, embarrassed, worried, confused
b) happy and confident
6. How would you strike a rapport with an adolescent client?
a) By not asking too many questions and not making eye contact
b) By friendly, warm and non-judgmental behaviour with positive
non-verbal cues.
c) Frowning and stern behaviour.
d) None of the above..
Pre-test

7. Adolescents do not utilise available health services because:
a) they fear the health providers will inform their parents.
b) they are not interested.
c) they do not recognise illness.
d) they do not know where to go.
e) All of the above.
f) None of the above.
8. What are the barriers to good communication?
a) Servicer providers use simple words and language
b) Client feels comfortable
c) Lack of privacy
d) Adolescents are unable to talk because of fear
e) Insufficient time to explain
f) (a) and (b)
g) (c, d and e)
9. What problems are caused by lack of menstrual hygiene?
a) Anaemia, weakness, diarrhoea
b) Malaria, worm infestation
c) Vaginal discharge, burning during urination and genital itching
10. According to you, how will you rate masturbation for adolescent boys and girls.
a) Normal behaviour
b) Abnormal behaviour
c) Shameful behaviour
11. Lack of nutrition in adolescence can cause-
a) Protein - energy malnutrition
b) Stunting of growth
c) Anaemia
d) All of the above
e) None of the above
12. Night fall in boys is
a) Abnormal
b) Normal
c) Sign of serious illness
13. What is the risk of maternal death among women aged 15-19 years as compared
to women aged 20-35 years?
a) Lower
b) Higher
c) Equal
Pre-test

14. What can anANM/LHV do to prevent unsafe abortions in pregnant adolescents?
a) Counsel and refer to appropriate facility for termination of
pregnancy
b) Conduct termination of pregnancy yourself
c) Scold her for getting pregnant and tell her to continue her pregnancy
now and take some contraception after delivery
15. Which contraceptive methods are appropriate choice for adolescents?
a) Abstinence, condoms and oral pills
b) Sterilisation, Fertility-awareness based methods and IUCD
16. What canANMs/LHVs do to prevent STIs among adolescents?
a) Cannot do anything
b) Counsel them that abstinence, being faithful to one's partner
and use of condoms protect from STIs
c) Criticise unmarried sexually active and inform the parents of
sexually activer unmarried adolescents of their shameful behaviour
17. After unprotected sex, emergency contraceptive pills can be given to:
a) Married adolescents
b) Unmarried adolescents
c) Both
d) None of the above
18. Which health services canANM provide to adolescents?
a) ___________ Providing information and counselling
b) ___________ Screening for health problems
c) ___________ Identifying and managing some problems
d) ___________ Referring to other health services providers when
necessary
19. What are the most important characteristics of adolescent-friendly health
facilities?
a) ___________ Non-threatening environment
b) ___________ Privacy and confidentiality maintained
c) ___________ Non-judgmental service providers
d) ___________ Accessible and approachable
20. Which contraceptive methods protect from pregnancy and STIs/HIV (dual
protection)?
a) ___________ Abstinence
b) ___________ Condoms
Note: Each question is of 1 mark. If the answer is correct for the whole question
score 1 for it. In the end add up the total marks obtained and calculate the score %
of dividing marks obtained with maximum marks 20 and multiply by 100. Example:
if a participant scores 15 marks. Her score % is
75%x100
20
15
=
Pre-test

Module
II
Module Introduction
Adolescence - A Period of Change
Looking Back on my Own Adolescence
Why Invest in Adolescent Health
and Development
Module Summary
(Total Time: 2 hrs)
AdolescentAdolescentAdolescentAdolescentAdolescent
GrGrGrGrGrooooowth andwth andwth andwth andwth and
DeDeDeDeDevvvvvelopmentelopmentelopmentelopmentelopment
Session 1
10 mins
Session 2
40 mins
Session 3
30 mins
Session 4
30 mins
Session 5
10 mins

II-2 Facilitator's Guide for ANMs/LHVs Orientation
Materials:
• Flipchart II-1
Module II
10 mins
SESSION 1
Module IntroductionModule IntroductionModule IntroductionModule IntroductionModule Introduction
Objectives:
• Get an overview of the module including its objectives.
ACTIVITIES TOPIC TRAINING TIME
METHODOLOGY
Activity 1 Introduction of Presentation 10 mins
Module II and
its objectives
Introduction
Adolescence (10-19 years) is a phase of life which has recently gained
recognition as a distinct phase of life with its own special needs. This
phase is characterized by acceleration of physical, psychological and
behavioural change thus bringing about transformation from
childhood to adulthood. This module defines adolescence and it aims
at generating an understanding of what is special about adolescence
and provides an overview of important matters concerning
adolescent health and development. It examines the perceptions of
adolescents and of adults regarding adolescents' health concerns and
explores the rationale for investing in adolescent health. This module
is a foundation for all the subsequent modules wherein issues
pertaining to adolescent health and development have been dealt with
in greater depth.

II-3Facilitator's Guide for ANMs/LHVs Orientation
Encourage the participants to ask questions and raise their
concerns, if any.
Activity 1
• Start by introducing the module's name and sessions.
• Put up Flipchart II-1 and present the module objectives to the
participants.
• Explain that this module looks at adolescence as a phase of life and its
implications on the health of adolescents.
• Remind the participants to put any questions/suggestions in the Mailbox after
completion of the Module.
Module
Introduction
FLIPCHART II-1
Module Objectives
By the end of this module, participants will
be able to:
• Define the term “adolescence”
• Describe the nature of changes during
adolescence
• Identify important health related issues and
concerns of adolescents
• List important reasons for investing in
adolescent health and development
• Be more empathetic towards adolescents.

Materials:
• Flipcharts II-2
• Flipcharts II-3
• Flipcharts II-4
• Flipcharts II-5
• Blank Flipcharts
• Markers
Module II
40 mins Objectives:
• Explain what is 'adolescence'.
• Explain the changes that occur during adolescence.
Activity 1
• Ask the participants what they understand by the term 'adolescence'.
Encourage them to state words that come to their mind when they think of
adolescence and note down the responses on a blank flipchart
• Ask the participants to open Handout II and read out What is "adolescence"
and explain its main points
Activity 2
• Divide the participants into 3 groups and give them the following group work:
Group 1: List physical changes that occur during adolescence in boys
and girls
Group 2: List changes sexual developmental changes in girls and boys
Group 3: List emotional and social changes that occur during adolescence
in both girls and boys
• Give participants 10 mins for group work to discuss amongst themselves and
come up with their respective list.
• Give blank flipcharts and markers to each group.
• After the small groups complete their lists make the entire group sit together
and have one person from each group to present the group work. Ask all the
group members to come forward while their representative is presenting their
response.After each group's presentation, ask the other two groups if they want
to add more points to the list or need any clarification.
• Put up the pre-prepared Flipchart II-2 containing the list of physical changes,
Flipchart II-3 sexual development and Flipchart II-4 of emotional and social
changes after respective group work presentations for comparison.
• Invite any additional comments and suggestions.
SESSION 2
Adolescence -Adolescence -Adolescence -Adolescence -Adolescence - A PA PA PA PA Period oferiod oferiod oferiod oferiod of
ChangeChangeChangeChangeChange
METHODOLOGY
Activity 1 What is "Adolescence" Brainstorming 10 mins
Activity 2 Changes/events that occur Group Work 20 mins
during adolescence
Activity 3 Health Implications Group work 10 mins

Adolescence - A
Period of Change
FLIPCHART II-2
Physical events/changes
BOYS
• Growth spurt occurs
• Muscles develop
• Skin becomes oily
• Shoulders broaden
• Voice cracks
• Underarm and chest
hair appears
• Pubic hair appears
• Facial hair appears
• Penis and testes
enlarge
• Ejaculation occurs
GIRLS
• Growth spurt occurs
• Breasts develop
• Skin becomes oily
• Hips widen
• Underarm hair
appears
• Pubic hair appears
• External genitals
enlarge
• Uterus and ovaries
enlarge
• Menstruation begins
FLIPCHART II-3
Sexual Development
• Sexual organs enlarge and mature
• Erection in boys
• Sexual desire
• Sexual attraction
• Menarche, Ovulation
• Sperm Production, Ejaculation
• Initiation of sexual behaviours

Adolescence - A
Period of Change
Activity 3
• Draw the participants attention to the fact that adolescent boys and girls
acquire distinct characteristics due to the various changes that occur in their
bodies, mind, feelings and behaviour.
These characteristics make them vulnerable to risks which have health
implications e.g. they take many health risks due to their tendency to try out
new things and the health consequences may be very serious.
• Explain that now through group work (same 3 groups), we will correlate the
characteristics of adolescence with their possible health implication. Refer them
toAnnexure 1, Group exercise in Handout II.
• Give each group a flipchart and marker pens. Ask each group to write the
possible health implications due to changes they recorded in their previous
flipchart. Give the participants 5 minutes to write their responses.
• After the participants have finished, ask each group to present their findings.
Appreciate the groups' response and ask if other groups want to add more to
the presentation made by the group.
• Give flipcharts and markers to each group and ask them to keep writing down
like a flow chart what risks can the adolescents take due to their characteristics
and what will they lead to.
• Give them 15 mins to complete the work.
• One person from each group to present their work.
• Summarize the health implications of other changes during adolescence by
displaying Flipchart II-5.
FLIPCHART II-4
Emotional and Social Changes
• Preoccupied with body image
• Want to establish own identity
• Fantasy / daydreaming
• Rapid mood changes, Emotinal
instability
• Attention seeking behaviour
• Sexual attraction
• Curious, Inquisitive
• Full of energy, Restless
• Concrete thinking
• Self exploration and evaluation
• Conflicts with family over control
• Seek affiliation to counter instability
• Peer group defines behavioural code
• Formation of new relationships

Adolescence - A
Period of Change
Some participants may point out that the events and changes
being discussed are due to underlying factors, such as inherited
hormonal changes. Acknowledge that this is correct
and stress that the focus of the session is on the events and changes
that occurs, and not on the factors that cause them.
FLIPCHART II-5
Changes during Health Implications
Adolescence
Physical Changes
• Normal growing-up Undue anxiety and tension
• Increase in height and Increase nutrition requirement – if
weight inadequate, undernutrition and anemia
• Breasts Development Stooping of shoulders, poor posture,
back pain
• Skin becomes oily Acne
• Desire to be thin, have a good Protein-energy malnutrition, anemia, Stunting
figure
Sexual Development
• Desire to have sex Unsafe sex leading to unwanted pregnancy,
STIs, HIV; Need of health education and
services
• Ejaculation Fear, guilt, myths - emotional problems
• Menstruation Dysmenorrhea, Menorrhagia - Anemia, RTI
(Menstrual Hygiene)
Emotional changes and Social development
• Dvelopment of Identity Confusion, moodiness, irritation
• Very curious Experimentation, Risk taking behaviour
• Peer pressure Effect on • Unhealthy eating habits
life styles leading to obesity
• Smoking and alcohol use leading
to ill health
• Speed driving, accidents
• Facilitator to wrap up the group work by saying that adolescents are vulnerable
to so many health risks just because of normal development and we as
service providers need to provide support to them.
Some participants may point out that the events and changes
being discussed are due to underlying factors, such as inherited
traits and hormonal changes. Acknowledge that this is correct
and stress that the focus of the session is on the events and
changes that occurs, and not on the factors that cause them.

METHODOLOGY
Activity 1 Participants' reminiscing Group Work & 20 mins
their personal experiences discussion
as adolescents
Activity 2 Issues and concerns of Brainstorming 10 mins
adolescents earlier and those
of adolescents today
Activity 1
1. Divide the participants into four groups. Tell the participants that during this
activity they will explore their own experiences as adolescents. They must
be truthful and frank in their explorations.
2. Put up Filpchart II-6 and ask the participants to share their experience within
the small groups, based on the questions posted on the Flipchart II-6 and
note down their groups' responses on a flipchart. Give them 15 minutes for
this excercise.
Objectives:
• Empathise with the clients.
• Identify the issues and concerns of adolescents today as compared to
those of adolescents earlier.
SESSION 3
Looking Back on my OwnLooking Back on my OwnLooking Back on my OwnLooking Back on my OwnLooking Back on my Own
AdolescenceAdolescenceAdolescenceAdolescenceAdolescence
Materials:
• Flipcharts II-6
• Markers
Module II
30 mins
FLIPCHART II-6
Task for group work
Discuss your experiences as an adolescent
• What was your adolescence like ?
• What were the things most important to you ?
• What were your fears ?
• What was your experience when you started your
periods/had nightfall?
• Who gave you information related to periods/
nightfall?
• Whom did you talk to if you needed support?

Looking Back on my
Own Wonder Years
• After the group work, ask the group representative to share the groups'
responses.
• Once all the groups have made their presentations, generate a discussion
about what are the common issues and concerns during adolescence and
note down their responses on a Flipchart
• Now, ask them of they can recall instances when adolescents came to them
(as service providers) with their problems and how they dealth with the
adolescent and his/her problem.
Listen to their responses.
• Then sum up by saying that empathising with adolescent girls and boys will
help ANMs/LHVs develop better rapport with them and will give them
confidence to deal with their problems effectively.
Note that this activity may unleash strong feelings (such as sadness
or anger). Be on the lookout for this, and be prepared to respond
if any participant wishes to talk about his/her thoughts and
feelings with you.
Activity 2Activity 2Activity 2Activity 2Activity 2
• Ask participants what are the similarities and differences between the
experiences and concerns of adolescents today and their own times.
• As the participants raise points of similarity or difference, note them on a flipchart
and ask them to encourage interaction between the participants.Ask them to
respond to each other’s comments and questions, and stress that by sharing
experiences and opinions, they will contribute to each other’s learning.
Emphasise that the range of possible different experiences during adolescence
can be attributed to differences in sex, age, family environment, socio-economic
conditions, culture and place of residence, media-TV, magazines, newspapers
and movies.
• Lead them to the fact that though there may be many differences the fact
remains that the adolescents face similar problems and have similar concerns
as you had in your times.

Module II
Materials:
• Flipchart II-7
• Flipchart II-8
• Flipchart II-9
• Markers
30 mins
Activity 1
• Present the scenario related to adolescents in India:
Objectives:
• Present important reasons for investing in adolescent health and development
SESSION 4
WWWWWhhhhhy Iny Iny Iny Iny Invvvvvest inest inest inest inest in AdolescentAdolescentAdolescentAdolescentAdolescent
Health and DeHealth and DeHealth and DeHealth and DeHealth and Devvvvvelopment?elopment?elopment?elopment?elopment?
METHODOLOGY
Activity 1 Scenario related to Presentation 10 mins
adolescents in India
Activity 2 Health Problems Brainstorm 10 mins
Activity 3 Reasons for investing in Discussion 10 mins
adolescent health and
development
• Brainstorm the health problems that adolescents may encounter.
FLIPCHART II-7
?Adolescents comprise a sizeable population - there are 243 million
adolescents
?47% of Indian women were married before they attained the age of
18 years (NFHS 3).
?Maternal mortality rate due to teenage pregnancy is 9% (2007-2009)
?TFR amongst 15-19 yrs old is 14% in urban and 18% in rural of the
total fertility (NFHS 3).
?Unmet need for contraceptives - The contraceptive knowledge is
quite high among adolescents but there are high gaps between
knowledge and usage. Unmet need of family planning in the 15-19
age group is 27% (NFHS 3).
?More low birth babies by mothers age <20 years.
?Economic compulsions force many to work - Nearly one out of three
adolescents in 15-19 years is working.
?More than 33% of the diseases burden and almost 60% of premature
deaths among adults can be associated with behaviors or conditions
that began or occurred during adolescence for ego Tobacco, alcohol
use, poor eating habits, sexual abuse and risky sex (WHO 2002).
?Crimes against adolescents are prevalent. According to a survey, in
84 % cases, the victims knew the offenders and 32 % of the offenders
were neighbours.
?Misconceptions about HIV/AIDS are widespread. As per (NFHS 3)
awareness of STls’ and HIV/AIDS was limited in 15-24 yrs age
group. Young men and 15% of young women reported awareness of
STI.

Why Invest in
Adolescent Health and
Development?
• Put up Flipchart II-8 and run through it, emphasising on the points which did not
come out during brainstorming.
FLIPCHART II-8
Health Problem of Adolescents
Physical • Menstrual (scanty, irregular,
painful, excessive)
• Vaginal discharge
• Anaemia
• Growth less/more than others
• Problems due to teenage
pregnancy and unsafe abortions
• RTIs/STIs and HIV
• Problems due to use of tobacco,
alcohol, drugs
Emotional • Depression
• Stress due to nightfall,
masturbation etc.
• Overweight/obesity/under nutrition

Why Invest in
Adolescent Health and
Development?
Activity 2
• Ask participants why we should invest in adolescent health. Listen carefully to
them.
• Then display Flipchart II-9 and read it out.
• Sum up the discussion and invite any further comments or suggestions.
Reiterate that what adolescents do today will have an influence on their health
as adults and on the health of their children, in future. Stress at improvements
in the health of adolescents will increase their achievements in school and will
lead to greater productivity.
FLIPCHART II-9
Reasons for investing in adolescent health and
development
• To develop their capacity to cope with daily life
situations and deal with them effectively
• To inculcate healthy habits and behaviours so as
• To reduce morbidity and mortality in adolescents
• To impact National indicators like highTFR, MMR
& IMR, arrest HIV epidemic
• A healthy adolescent grows into a healthy adult,
physically, emotionally and mentally - maximize
potential and productivity
• Economic benefits: Increased productivity, averting
future health costs of treating AIDS, tobacco
related illness, life-style related illness is like
• As a human right, adolescents have a right to
achieve optimum level of health
to prevent injuries, violence and NCDs
Diabetes, highblood pressure, and stroke

Module II
Key points:
• Adolescence (10-19 yrs) is a period of rapid physical growth and emotional
changes.
• Adolescents today are more vulnerable to health risks and their implications
due to their nature of experimenting and exposure to limited information.
• Investing in adolescents will be a 'demographic bonus' later when they become
responsible and well informed adults.
SESSION 5
Module SummarModule SummarModule SummarModule SummarModule Summaryyyyy
10 mins

Module
III
Dealing
with thewith thewith thewith thewith the
AdolescentAdolescentAdolescentAdolescentAdolescent
ClientClientClientClientClient
Module Introduction
Communication and Counselling Skills
Module Summary
(Total Time: 2 hours)
Session 2
1 hrs 30 mins
Session 3
15 mins
Session 1
15 mins

III-2 Facilitator's Guide for ANMs/LHVs Orientation
Module IntroductionModule IntroductionModule IntroductionModule IntroductionModule Introduction
Objectives:
• Get an overview of the module and its objectives.
Activity 1
• Welcome the participants and request one participant to recap previous day's
activities. Introduce participants to Module III.
• Put up Flipchart III-1 and have a participant volunteer read out the objectives.
SESSION 1
Materials:
• Flipchart III-1
Module III
15 mins
• Explain that this module looks at effective communication and counseling skills
thatANMs/LHVs may find useful in their day to day interaction with adolescent
clients.
FLIPCHART III-1
Module Objectives
By the end of this module, participants will
be able to:
• Demonstrate effective communication skills
• Demonstrate effective counseling skills to use
when interacting with adolescent clients
METHODOLOGY
Activity 1 Module Objectives Presentation 15 mins
Introduction
Communication plays a vital role in everybody’s life. Communication
is a process through which we convey our thoughts and feelings to
other people. One of the major components of communication is to
listen and to understand others’ points of view and feelings.
Communication is more effective if it is two-way rather than one-way.
The exercises in this module involve discussion, behavior change and
positive and negative role-plays. It will help ANMs/LHVs to
understand the realities and the mindset of their adolescent client and
will foster better communication and responsiveness to their needs.

III-3Facilitator's Guide for ANMs/LHVs Orientation
Communication andCommunication andCommunication andCommunication andCommunication and
Counselling SkillsCounselling SkillsCounselling SkillsCounselling SkillsCounselling Skills
Objectives:
• Describe the communication barriers that adolescents face in obtaining
sexual and reproductive health information and services.
• Describe and what could be done to address them.
• Identify and practice effective communication skills.
• Explain counselling skills.
Activity 1
• Ask the participants - "What do you understand by "communication"?
• Put the responses on a flipchart.
• Put up Flipchart III-2 and explain the meaning of "communication".
SESSION 2
Materials:
• Flipchart III-2
• Flipchart III-3
• Flipchart III-4
• Flipchart III-5
• Flipchart III-6
• Flipchart III-7
• Markers
Module III
2 hrs
METHODOLOGY
Activity 1 What is communication Brainstorming 30 mins
and what are the barriers Role Play
to communication
Activity 2 Verbal and non-verbal Brainstorming 10 mins
communication
Activity 3 Counselling and its Steps Mini lecture 30 mins
Activity 4 Counselling Skills Role Plays 20 mins
FLIPCHART III-2
What is Communication?
It is the art of expressing and exchanging ideas,
thoughts and feelings through speech, gestures or
writing
• Tell the participants that now you will enact a Role Play with the co-faclilitator.
They should observe it carefully as there will be a discussion on it later on.
Perform the Role Play. (One facilitator to play the role ofANM and the other to
play the role of an adolescent girl.Elicit a typical setting where the ANM is
busy,surrounded by a lot of people/disturbance and does not give attention to
the girls' concerns)
• Now ask participants what they saw in the role play? Brainstorm the barriers of
communication in the role play. List out the feelings of the girl on a flipchart.

• Ask the participants what they think adolescents feel when they walk
into a PHC, or stand before an ANM. List out the feelings on a flipchart.
[Possible answers may be that adolescents feel shy, embarrassed,
worried, anxious, inadequate - not confident to talk to adults, defensive,
resistant, etc.]
• Then, ask the participants what, as ANMs/LHVs, they can do to put the
adolescent client at ease. Note down their responses on a blank flipchart.Add
to the list,if required.
[Possible answers may be establishing trust, being non-judgemental, using
simple language, reasoning with the young client, maintaining confidentiality
and privacy, etc.]
• Put up Flipchart III-3 and tell the participants that these are some of the barriers
thatANMs/LHVs face when communicating with adolescents in a health-centre
setting.
• Discuss with them how they can remove these barriers in their own work setting.
Role play Scenario
ANM is sitting in her centre. A14-year old girl comes to her as she is having a lot
of pimples on her face since 2 months. She is hesitant to talk to the ANM as
there is a lot of noiseand disturbance by other patients and their relatives outside
the clinic room and the ANM is not paying attention to her. When she picks up
courage to tell her problem to theANM, theANM does not look at her and keeps
filling her daily register while talking to the girl. Then the ANM advises the girl
briefly not to worry about her pimples and it is normal in this age due to hormonal
spurt. She expects the girl to go but the girl is hesitant to go. She is confused as
she does not understand the difficult words used by theANM and she has more
problems.ANM asks her why she is waiting? Then the girl tells herperiod is less
than her friends so she is worried about it. TheANM briefly asks her menstrual
history and tells her not to compare herself with her friend. The girl is scared to
ask any more and goes away.
Communication and
Counselling Skills
• End the session by reiterating the fact that while providing health services to
adolescent clients ,it is crucial to put them to ease ,make them comfortable and
give them full attention and patient hearing.
FLIPCHART III-3
Barriers to communicating with an adolescent
client in a PHC and Sub-centre:
• Too much noise and distraction
• Lack of privacy
• Inability to make the adolescent feel
comfortable
• Use of medical terms- complicated, unfamiliar
words for the adolescent
• Too much information given
• Own perception, beliefs and values clash with
the adolescent's needs
• Not enough time devoted with the adolescent client
• No follow up services

FLIPCHART III-4
Positive non-verbal actions
• Smiling without showing tension
• Facial expressions which show interest and
concern
• Maintaining eye contact with the client
• Encouraging supportive gestures such as
nodding one’s head
• Avoiding nervous mannerisms
• Appear attentive and listening
Activity 2
• Tell the participants that they will now be discussing the key components of
interpersonal communication.Discuss the importance of active listening
• Emphasise that there are many different nonverbal and verbal behaviours that
ANMs/LHVs use while communicating with clients. Sometimes, without realising
it, they communicate one message verbally, while communicating the opposite
message nonverbally. Mention that non-verbal actions may also be "positive"
or "negative".
• Put up Flipchart III-4 (with only the title) and ask the participants to brainstorm
on “positive non-verbal actions”.
• Put down the responses on the flipchart. Afew examples have been mentioned
on Flipchart III-4 below, but the list is not exhaustive.
• Put up Flipchart III-5 (with only the title) and ask the participants to brainstorm
on “negative non-verbal actions”.
• Put down the responses on the flipchart.Afew examples have been mentioned
on Flipchart III-5, but the list is not exhaustive.
Communication and
Counselling Skills
• Repeat Role Play: Request two participants to repeat the role play done
earlier by facilitators. The 'ANM' should now be able to demonstrate
good communication skills.
FLIPCHART III-5
Negative non-verbal actions
• Not making or maintaining eye contact
• Glancing at one’s watch obviously and more
than once
• Flipping through papers or documents
• Frowning
• Fidgeting
• Sitting with arms crossed
• Leaning away from the client
• Yawning or looking bored

Communication and
Counselling Skills
Activity 3
• Ask the participants what they understand by the term Counselling? Listen
carefully to their answers. Then put up Flipchart III-6 and explain the meaning of
Counselling.
• Tell the participants that if they offer good counselling, more adolescents will
make healthy choices. More adolescents will be happy with their care. They
will come back when they need help.
• Emphasise that counselling often has 6 elements, or steps. Each letter in the
word GATHER stands for one of these elements. Good counselling is more
than covering the GATHER elements, however. A good counsellor also
understands the adolescent's feelings and needs. With this understanding, the
counsellor adapts counselling to suit each adolescent. Good counselling need
not take a lot of time. Respect, attention to each adolescent's concerns, and
sometimes just a few more minutes make difference.
• Ask the participants if they know what "GATHER" stands for.
• Put up Flipchart IIII-7 and read it out.
FLIPCHART III-6
What is Counselling?
It is face to face communication between two or
more people in which one person helps the other to
make a decision and then act upon it. :
• It is two way communication and the counselor
listens patiently to the clients' thoughts/fears/
misconceptions/problems without being
judmental.
Takes into account psycho-social, emotional
and spiritual needs of the client
• Is strictly confidentional
• Information given to the client is full and
accurate
• Helps the client to make decisions for himself
or herself
• Ask volunteerrs to take turns to read aloud what comes under 'G', 'A', 'T', 'H', 'E',
and 'R', from Handout III. Finally, open the floor for discussion.
• Conclude this session by asking participants to read Handout III in their spare
time.
FLIPCHART III-7
G = Greet the person
A = Ask how can I help you?
T = Tell them any relevant information
H = Help them to make decisions
E = Explain any misunderstanding
R = Return for follow up or Referral

Communication and
Counselling Skills
The GATHER approach
for counselling
Greet the adolescents
• put them at ease, show respect and trust
• emphasize the confidential nature of the discussion
Ask how can I help you?
• ask how can I help you?
• encourage them to bring out their anxieties, worries and needs, determine
their access to support and help in their family and community;
• find out what steps they have already taken to deal with the situation
• encourage the person to express his/her feelings in own words
• show respect and tolerance to what they say and do not pass judgement
• actively listen and show that you are paying attention through your looking
• encourage them through helpful questions
Tell them any relevant information they need:
• provide accurate and specific information in reply to their questions
• give information on what they can do to reamain healthy. Explain any
background information they need to know about the particular health
issue
• keep your language simple, repeat important points and ask questions to
check if the important points are understood
• provide the important information in the form of a leaflet if possible that
they can take away
Help them to make decisions
• explore the various alternatives
• raise issues they may not have thought of
• be careful of letting your own views, values and prejudices influence the
advice you give
• ensure that it is their own decision and not one that you have imposed
• help them make a plan of action
Explain any misunderstandings
• ask questions to check understanding of important points
• ask the person to repeat back in their own words and key points
Return for follow-up or Referral
• make arrangements for a follow-up visit or referral to other agencies
• if a follow-up visit is not necessary, give the name of someone they can
contact if they need help

Communication and
Counselling Skills
Activity 4
• Divide the participants into four small groups by counting off 1,2,3,4.
• Put the one’s in Group 1, two's in Group 2 and so on.
• Give each group a Role play scenario. (Scenario 1 to Group 1, Scenario 2 to
Group 2 and so on).
• Give the groups 10 mins to talk about the scenario and prepare the role play.
• Have each group come up and read out the scenario to the large group and
present their role play.
• While one group is presenting, the others will act as “observers”, making their
responses on the “Observer Roleplay Checklist” given in Handout II.
• After each role play, ask the participants to share their comments with the
group (both positive and negative).
• Tell the participants, that when they speak with adolescents, it is important to
use “simple language”. If certain reproductive health terms had been used that
adolescents may not easily understand, ask the group to suggest words that
they can use instead.
• Emphasise that it is important for ANMs/LHVs to be conscious of their
interactions with adolescents. It is also important to make their young clients
comfortable during the first visit. Encourage them to come for other visits if they
need to. Tell the participants that adolescents are extremely aware of and
sensitive to non verbal messages. Explain that improving communication and
counseling skills will contribute to quality services for adolescents.
• Tell the participants that a training like this may not make 'counselors' out of
them. But, certainly, they will be able to help many adolescents to handle their
day-to-day problems. Once they realize that an adolescent has a higher level
of psychopathology they should immediately refer such a client to a
professionally qualified person.
Remember that communicating with adolescents is very difficult
because they are not willing to talk to adults about their worries
and apprehensions of life due to the lack of confidence in
themselves and in others.
They have not been able to build relationships with adults around
them.

Communication and
Counselling Skills
Observer Role-play Checklist to critique
communication skills
Note: Please mark a '3' in the appropriate column while observing the tasks and
characteristics of the communication of the provider during the role play.
What did you learn from observing this role play?
______________________________________________________________
______________________________________________________________
______________________________________________________________
Please record your comments/observations for feedback to participants (both
positive and negative):
______________________________________________________________
______________________________________________________________
TASK PERFORMED
YES NO
Nonverbal Communication
Friendly/ welcoming/ smiling?
Non-judgemental/ empathetic?
Listens/attentive/ nods head to encourage and
acknowledge client's responses?
Allows client enough time to talk?
Verbal Communication
Greats client
Asks clients about themselves
• Obtaining history
- name, age, address, married/unmarried
- basic medical information
- family history
- menstrual history (for girls)
- social habits (smoking, alcohol, tabacco, gutka)
- number of children, if married
- contraceptive use (now and/or in the past)
- asks client about her/his problem
Tells clients about their choices/options.
Helps clients choose
Explains what to do
Counsels to return for follow-up
Language was simple and brief

Communication and
Counselling Skills
Scenario 4
A 16-year-old adolescent boy comes to the clinic because sometimes he has
felt and seen some thick fluid come out of his penis at night while sleeping.
How will you counsel the boy?
Scenario 1
A13-year-old girl comes to your health centre with her mother because she feels
some white discharge is coming out of her private parts which stains her salwar.
She also has a lot of pain during her periods.
How will you counsel the client?
Scenario 2
A 16-year-old married adolescent girl, with a three month-old baby wants to
postpone her next pregnancy. Her sister uses oral contraceptive pills and likes
that method very much. She says she wants to use it.
Scenario 3
Ayoung couple accompanied by the husband’s mother, comes to see you. They
have been married for 3 months. The wife is 17 years old. The mother-in-law
insists that they should have a child as soon as possible as she wants a
grandson. The couple wants to postpone pregnancy for at least 2 years.
Role Play Scenarios

SESSION 3
Module SummarModule SummarModule SummarModule SummarModule Summar yyyyy
Key points:
• Communication is exchanging thoughts and ideas in speech or writing. It also
involves non-verbal actions while communicating.
• Counselling is communicating to help people make informed decision and provide
confidence to enable them put to their decisions into action.
• Inadequate communication on sexual and reproductive health matters and social
taboos attached to them along with feelings of adolescents makes communication
challenging with them.
• Establishing trust, encouraging, friendly and non-judgmental patient attitude of
provider ensuring confidentiality help build effective communication.
• Effective counseling can gradually bring about behaviour change in adolescents.
• Issues regarding sexuality, gender and decision making should be looked for
and addressed during counselling.
Module III
15 mins

ModuleModuleModuleModuleModule
IVIVIVIVIV
Adolescent-Adolescent-Adolescent-Adolescent-Adolescent-
FFFFFriendlriendlriendlriendlriendlyyyyy
Health SerHealth SerHealth SerHealth SerHealth Servicesvicesvicesvicesvices
Introduction and Health Services for
Adolescents
Making Services Adolescent Friendly
Adolescent Friendly Health Clinic
Module Summary
(Total Time: 2 hrs 30 mins)
Session 1
40 mins
Session 2
1 hr 15 mins
Session 3
20 mins
Session 4
15 mins

IV-2 Facilitator's Guide for ANMs/LHVs Orientation
Activity 1
• Welcome the participants and request one participant to recap previous days
activities and ask them to mention any new knowledge gained the previous day.
• Put up Flipchart IV-1. Have the participants read out the objectives to Module IV.
SESSION 1
Introduction & HealthIntroduction & HealthIntroduction & HealthIntroduction & HealthIntroduction & Health
SerSerSerSerServices fvices fvices fvices fvices fororororor AdolescentsAdolescentsAdolescentsAdolescentsAdolescents
Objectives:
• Get an overview of this module and its objective.
• Explain how health services can promote adolescent health and development.
Activities Topic Training Methodology
Time
METHODOLOGY
Activity 1 Objectives of Module IV Presentation 10 mins
Activity 2 How adolescent-friendly Group activity 10 mins
is my health facility?
Activity 3 Role of health services to Brainstorming 20 mins
promote adolescent health
Module IV
40 mins
Materials:
• Flipchart IV-1
• Flipchart IV-2
• Flipchart IV-3
• Flipchart IV-4
• Flipchart IV-5
• 3 cards
• Cards
• Markers
Introduction
FLIPCHART IV-1
Module Objectives:
By the end of this module, participants will be
able to:
• Explain how health services can promote
adolescent health
• Identify the charateristics of adolescent-friendly
health services
• Describe approaches to making health services
more adolescent-friendly
Services for adolescents must demonstrate relevance to the needs and
wishes of young people. This module looks at how to make health
services adolescent-friendly. It keeps in view the adolescent needs,
perspectives of different stakeholders, characteristics and
approaches to making health services more adolescent friendly.

IV-3Facilitator's Guide for ANMs/LHVs Orientation
• Ask participants what they understand by terms health, sexual and reproductive
health. Listen carefully to their answers. Then put up Flipchart IV-2 and explain
the terms
Activity 2
• Put up 3 cards with each of the following headings on 3 different walls of the
training room:
a) My health centre is not adolescent-friendly
b) My health centre is somewhat adolescent-friendly
c) My health centre is very adolescent-friendly
• Ask participants to stand near the card which they think most aptly describes
their health centre.
• Count the number of participants standing against each card. Write the numbers
of participants in each group on the card.
• Ask some volunteers why they think so?
Introduction and
Health services
for Adolescents
Activity 3
• Remind the participants of the exercise they did in Day-1 on Module 2 in which
they drew a flowchart on characteristics of adolescence and their health
implications e.g. attraction towards the opposite sex may lead to unprotected
sex, unwanted pregnancy and STIs etc. Refer to the flowchart and brainstorm
which health services can protect adolescents from grave health consequences
written on the flowchart? Example – giving full and correct information about
consequences of unprotected sex may make them aware and adolescents may
refrain from it OR counselling about use of contraceptives will protect adolescents
from unwanted pregnancies and STIs.
• Note down their responses on Flipchart IV-3.
• Now ask them which health services are we actually providing to adolescents?
Possible answers may be curative, school, health services and to some extent
health services. Note their responses on Flipchart IV-4.
FLIPCHART IV-2
Definitions:
• Health
Health is a state of complete physical, mental
and social well-being and not merely the absence
of disease or infirmity
• Gatekeepers
People who interact with adolescents on a regular
basis (parents, teachers, youth leaders)
People who do not interact with adolescents on
a regular basis (policy makers, administrators)

Introduction and
Health services
for Adolescents
FLIPCHART IV-4
Which health services are being provided
to adolescents?
•
•
•
•
•
FLIPCHART IV-5
What happens when health services do not
meet the needs of adolescents?
• The result is countless missed opportunities
for:
- Preventing health problems
- Promptly detecting and effectively
treating them
• Lack of faith on Health Services and
providers
• Increased unmet need for adolescent
centered health services
• Increased chances of adolescent ill-health
• Draw their attention to the fact that there remains a big gap between the health
services that adolescents need and those which we provide to them
• Ask what happens when there is a gap between adolescent needs and health
services provided? Listen carefully to their responses. Then put up Flipchart IV-
5 and explain it. emphasise that it is out duty to bridge this gap so that adolescents
health needs are fulfilled.
• Ask participants to refer to Handout IV "What health services do adolescents
need?"
• Answer questions posed by the participants.
FLIPCHART IV-3
What health services do adolescents
need?
•
•
•
•
•

• Ask the participants to copy the 9 dots on cards and try to figure out a way to
connect all the dots with 4 straight lines joined together (drawn without lifting the
marker from the paper).
• Give the participants a few minutes to figure out the problem. You may find that
most participants will try to draw lines that do not go outside the imaginary
square formed by the 9 dots. Some may even conclude that it is impossible to
join all the dots with only 4 straight lines.
SESSION 2
MakingMakingMakingMakingMaking SerSerSerSerServicesvicesvicesvicesvices AdolescentsAdolescentsAdolescentsAdolescentsAdolescents
FFFFFriendlriendlriendlriendlriendlyyyyy
METHODOLOGY
Activity 1 Taking off our "blinders" Individual problem 10 mins
solving
Activity 2 Different perspectives on Group Work 30 mins
making it easier for
adolescents to get the health
services they need
Activity 3 Characteristics of Adolescents Presentation 10 mins
friendly health services
Activity 1
• Tell the participants that in order to provide adolescents with the health services
they "need", we need to tear off the conventional "blinders" that limit our vision
and imagination.
• Put up Flipchart IV-6, with nine dots on it.
Objective:
• Understand the perspectives of adolescents, health-care providers, and other
adult "gatekeepers" on the provision of health services to adolescents.
Module IV
Materials:
• Flipchart IV - 6
• Markers
1 hr 10 mins
FLIPCHART IV-6
• • •
• • •
• • •
Activity 4 Gender Issues Power walk 20 mins

• If someone can solve the problem, ask him/her to come up and share it with the
rest of the group. If no one has solved the problem, put up Flipchart IV-7 and
show them how to connect the dots.
Making Services
Adolescent
Friendly
• Tell the participants that in order to solve the problem, they had to "go beyond"
the limits they set for themselves. The lines must extend beyond the imaginary
"box" formed by the dots.
• Ask them the following questions:
• In what way is the Health Centres and the service providers like the
box formed by the dots?
• What can we do to help each other climb out of the "mental boxes" that
confine our thinking, so we can explore new ways with open minds? How is
this important when we work with adolescents?
Activity 2
• Divide the participants into four groups by counting off 1, 2, 3, 4.
• Give a number to each group (Group 1 to Group 4).
FLIPCHART IV-7
• • •
• • •
• • •

Making Services
Adolescent
Friendly
• Give each group the appropriate question (i.e., Group 1 should get question 1
and so on).
FLIPCHART IV-9
What do adolescents feel about the
attitude of ANMs/LHVs and visiting the
health facilities?
• there are no seperate or special health
services for adolescents
• don't maintain confidentiality
• unfriendly
• stern
• judgemental
• give lectures
• don't understand
• services provided are only for children
and married couples
• timings not suitable
FLIPCHART IV-8
For what health problems do adolescents
need to visitANMs/LHVs at PHCs and Sub
centres
• menstrual disorders
• amenorrhoea
• genital tract infections
• concerns regarding physiological
responses
• contraception
• behavioural problems
• night ejaculation (nightfall)
• pregnancy (teenage)
• anaemia
• weight related issues

• Give each group a blank flipchart and ask them to write their responses on it.
Tell the participants that they have 15 minutes to deliberate and put their
responses to the specific questions.
• Give each group three minutes to present their responses to the question posed
to them, in the larger group.
• Encourage all the participants to respond to any questions or issues raised by
the other groups. Facilitator to add points if and when required.
Making Services
Adolescent
Friendly
FLIPCHART IV-10
What do you, as ANM/LHV, think will
make services attractive for adolescents?
• non-threatening environment
• friendly, non-judgemental service
providers
• a health care provider who listens and
understands their problems
• a health care provider who is empathetic
and counsels them
• convenient timings
FLIPCHART IV-11
In your role as a "gatekeeper" (parent,
teacher, uncle, aunt), what do you think will
make it easier for adolescents to get health
services they need?
• no stigma related to adolescents getting
health services
• girls health valued as much as boys health
• family willing to spend money on
adolescents
• empathetic and non-judgemental
gatekeepers
• teachers can pay more attention to young
boys or girls health

• Pin up Flipcharts IV-8 to 11, one by one after each group has discussed their
question. Read out the points written on these flipcharts and compare with
group's answers. (The answers given below on each flip chart are Tips for the
Facilitator and is not exhaustive).
• Summarize key issues arising in the discussion.
• Bring up the following two issues - if they have not been raised spontaneously
and encourage some reflection and discussion.
Ask:
• Are the viewpoints of parents (and other gatekeepers) different in regard to
adolescent boys and girls? If so, how and why?
• AsANM/LHV, we have an important role to play in ensuring the health and
development of adolescents. Those of us, who are parents of adolescents
have an important role to play in their health and development. How do these
roles relate to each other, and how does this affect the way we deal with our
adolescent clients/patients?
• Brainstorm with participants. How will they reorganise their clinic to make it
Adolescent-friendly. Note responses on flipchart
Activity 3
Characteristics of Adolescent friendly Health Service:
• Explain that providers should be sensitive to the needs of the adolescents and
should reorganise their facilities to provide adolescent friendly services.
• Put up Flipchart IV-12 and explain characteristics of adolescent friendly health
services.
Making Services
Adolescent
Friendly
• Non-threatening environment
• Accessible and approachable
• Convenient timings
• Adequate space and privacy
• Affordable
• Counselling services
• Caters to the needs of adolescents
• Non-judgemental service pro-
viders
• Maintaining Confidentiality
• Accurate information is given
• Patient hearing is given
• Young people are respected
• Increases self confidence of
adolescents
• Trained peer educators
FLIPCHART IV-12

FLIPCHART IV-13
Community level assistance
• School
• AWW and ASHA
• SHGs
• Mahila Mandal
• Youth clubs
• NGOs working in their area
• Ask participants who else in the community can assist them to provideAdolescent
Health Services. Put up a blank Flipchart and note participants responses and
compare them with the list an Flipchart IV-13.
Making Services
Adolescent
Friendly
Activity 4
Gender Issues
Discuss gender issues in health services. Ask what differences will be there in
their approach of client is a boy or a girl? List out gender based discrimation
practiced in community.
Explain the activity Gender Power walk and conduct the session depending on
the time available. SeeAnnexure for this activity
• Peer Leaders

Making Services
Adolescent
Friendly
1. Health services can help to meet adolescent needs, only if
they are part of a comprehensive programme. Adolescents
need:
• A safe and supportive environment that offers protection
and opportunities for development;
• Information and skills to understand and interact with the
outside world;
• Health services and counselling - to address the health
problems and deal with personal difficulties.
2. Health service providers cannot meet all these needs alone.
They can join or create networks that act together and
maximise resources. Inter sectoral approach is best –
Education and Health to work together. Community
mobilisation to be done to support and counsel adolescents in
home or community settings.
3. There is no single "fixed menu" of services suitable for every
region. Each district/state must develop its own package,
according to economic, epidemiological and social
circumstances.
• A package of basic health services must be tailored to local
needs,
• Reproductive health services and counselling are a high
priority in most places,
• Information and counselling are important elements to
support adolescents.
4. Adolescent-friendly health approach helps
• build a non-threatening environment at home and
community level for the adolescents.
• build trust in elders and health services
• bring about behavioural change in adults (parents) and
adolescents to seek timely help and utilize health services
better.

Making Services
Adolescent
Friendly
Annexure-1
Activity 4 Gender Issues
(DURATION: 30 minutes; MATERIALS: open space, identity chits for Power
Walk, power walk questions (the power walk questions may be modified
according to local needs);
Objectives: Participants are able to better understand how gender norms, roles
and relations can affect adolescent girls and boys differently and how gender
interacts with other social determinants of health and delivery of health services.
Instructions:
1. Inform the participants that they are going to do a role play. Call 7-8
participants and ask them to stand in a row – as if preparing for a race. Make
them stand in a manner so that everyone can observe them. Give them chits
on which their identities are written. Instruct them that for the duration of the
role play they have to become the person whose identity they have been
given (see the box on power walk identities). Ask the others to stand around
and observe.
2. Read the following instructions to the trainees who are participating in the
role play
I am going to read out a few statements to all of you. If you think, being the girl
or the boy in the chit given to you, you can do what I am reading out, please
come one step ahead. If you think you cannot do that, stay at your place.
Remember, you are the representative of the girls and boys. So when you
think about the statement, think about all boys and girls, and act accordingly.
After making sure that the participants have understood the instructions
properly, start the role play.
3. Read out the statements (see the box on power walk statements)
4. After reading these statements, ask the participants to observe their
positions – who is ahead and who is far behind.Also ask them to declare their
identities to the observers. Start a discussion on the following points.
o What do you see? Who is ahead? Why?
o Who had to stay behind? Why?
o Those who are behind, what do you feel?
o Those who are ahead, what do you feel?
o What are the bases of discrimination that you saw in this role play?
o Is it right/proper to discriminate between girls and boys like this? Why?
Why not?
o As an ANM/LHV/Nurse, what can you do to prevent or minimise this
discriminatio

Power walk identities
Making Services
Adolescent
Friendly
Adapted from Gender mainstreaming for health managers: a practical approach
(WHO, 2011a).
·16 year-old unmarried boy belonging to a backward caste
·14 year-old boy with physical disability
·Only son of parents with 3 sisters
·Amarried young man
·Newly married 17 year-old daughter-in-law
·Amarried girl with a 2 year-old son
·16 year-old girl belonging to a forward caste
·14 year-old girl with visual disability
Power walk identities
1. Iknowwheretofindthenearesthealthfacility
2. IfeelrespectedbytheANM
3. IcanseekservicesfromthehealthfacilitywhenandifIneedto
4. IhaveaccesstomoneythatIcanusetopayforhealthservices
5. Icantalkopenlyaboutmyhealthproblemtoamedicalofficer
6. Icantalkopenlyaboutmyhealthproblemtomyfamilymembers
7. Iamallowedtobetreatedbyanopposite-sexhealthcareprovider
8. I can read and understand health information posters at the health
facility
9. Icanbuycondoms
10. Icannegotiatecondomusewithmypartner/spouse
11. Icanrefusesexwithmypartner/spouse
12. Iamnotindangerofsexuallyabused

Activity 1
• Ask participants package of services they would like to offer inAFHC? Put
up Flipchart IV-14 and elicit the reponse from participants on a blank flipchart.
METHODOLOGY
Activity 1 Setting up a AFHC Brainstorming 20 mins
20 mins Objective:
• Describe how they would reorganise the services at their facility to make it
adolescent friendly
SESSION 3
Adolescent FriendlyModule IV
Materials:
• Flipchart IV-14
• Flipchart IV-15
• Flipchart IV-16
• Markers
FLIPCHART IV-14
Package of service at Adolescent Friendly
Health Clinic may include
Health Clinic
BMI screening
Hb testing
RTI/STI management
ANC for pregnant adolescents
Counseling on Nutrition, puberty related concerns,
Pre-marital Counseling, Sexual Problems,
Contraceptive, Abortion, RTI/STI, Substance
abuse, Learning problems, Stress, Depression,
Suicidal Tendency, Violence, Sexual Abuse, Other
Mental Health Issues, , health lifestyle, risky
behaviour
Management of Menstrual problems
Management of Iron deficiencyAnaemia
Screening for diabetes and hypertension
Management of common adolescent health
problems
HIV testing and couselling
Management of physical violence and sexual abuse
Linkages with de-addiction centres and referrals
Treatment by specialists
Referral

• Ask participants additional equipment and supplies they would require for
Adolescent Clinic? Put up Flipchart IV-15. Probable answers may be BCC
material, Emergency Contraceptive Pills. Note their responses on blank flipchart.
• Ask participants how will they monitor their services. Note their responses on a
blank flipchart and compare with Flipchart IV-16.
Adolescent Friendly
Clinic/ Teen Clinic
FLIPCHART IV-15
Supplies required to provide Adolescent
services:
• IEC material
• Sanitary Napkins
• Contraceptives including Emergency
• Tetanus toxoid injection
FLIPCHART IV-16
How would you like to monitor utilization of
services at these clinics eg.
• Increased no. of adolescent coming to clinic
• Reduction in teenage pregnancy
• Increase inANC coverage in the pregnancies
• Reduced prevalence of RTI/STI
contraceptive pills
• Pregnancy Testing kits
• Iron and folic and tablets
• Other medicines (eg Paracetamol,
anlespasmodic and first aid)

Facilitator's guide anm_lhv

More Related Content

Facilitator's guide anm_lhv