Essential Training Package for HPV Vaccine Introduction Module

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Essential Training Package for HPV Vaccine Introduction Module 7 Taking care of adolescent patients

Essential Training Package for HPV Vaccine Introduction Module 7 Taking care of adolescent patients Cervarix. TM

Learning objectives l At the end of the module, the participants will be able

Learning objectives l At the end of the module, the participants will be able to: – Describe what we mean by adolescence – Understand how adolescent development and adolescents’ characteristics may affect their health and health behaviors including vaccination – Understand key issues to consider when taking care of adolescent patients l Duration – 60' 2| Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

Key issues 1 What is special about adolescence? 2 How do characteristics of adolescents

Key issues 1 What is special about adolescence? 2 How do characteristics of adolescents affect my work? 3 3| How to take care of adolescent patients? Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

Definition of adolescence l WHO definitions: – – Under-five child 0 -4 years Older

Definition of adolescence l WHO definitions: – – Under-five child 0 -4 years Older child 5 -9 years Adolescent 10 -19 years Young person 10 -24 years l UNICEF definition of the child – Child from 0 up to 18 years (as per Convention on the Rights of the Child) 4| Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

Adolescent development Physical Psychological Growth, sexual maturation and brain development Social Adolescent development Health

Adolescent development Physical Psychological Growth, sexual maturation and brain development Social Adolescent development Health 5| Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

Physical maturation Puberty involves changes in the body that lead to full growth and

Physical maturation Puberty involves changes in the body that lead to full growth and sexual maturation: – physical and psychological changes enabling reproduction – activation of a complex neuro-endocrinal network that regulates changes in the whole body including in the brain 6| Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

Sexual maturation l Onset of puberty typically occurs between 9 -13 years old in

Sexual maturation l Onset of puberty typically occurs between 9 -13 years old in girls and 10 -14 years old in boys maturation A child 5 - 7 years old 7| A physically mature adolescent girl 15 to 17 years Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

Brain maturation l Many brain changes occur during adolescence l Profound changes occur in:

Brain maturation l Many brain changes occur during adolescence l Profound changes occur in: – brain connections – signalling mechanisms – the pre-frontal cortex l The pre-frontal cortex is responsible for: – organizational ability – strategic thinking – impulse control l Brain changes are affected by social influences 8| Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

Psychological development Cognitive changes l A shift from ‘concrete’ to ‘abstract’ thought: – –

Psychological development Cognitive changes l A shift from ‘concrete’ to ‘abstract’ thought: – – Using hypotheses and deductive reasoning Visualizing the future and planning ahead Reflecting on one's thinking and learning from this Thinking beyond conventional limits l Occurs at a variable rate l Highly influenced by the social and cultural context 9| Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

Social development Identity formation occurs through adolescence: – Who am I? – What is

Social development Identity formation occurs through adolescence: – Who am I? – What is my place in the world? 10 | Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

What is special about adolescence? l A time of rapid physical and psychological (cognitive

What is special about adolescence? l A time of rapid physical and psychological (cognitive and emotional) growth and development l A time in which new capacities are developed l A time of changing social relationships, expectations, roles and responsibilities 11 | Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

In your point of view… What are typical characteristics of adolescents? Believe they are

In your point of view… What are typical characteristics of adolescents? Believe they are invulnerable Risk taking Don’t want to listen to parents 12 | Oriented on here and now, not on future Insecure Influenced by peers Vulnerable Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

How do characteristics of adolescents affect my work? (1/2) Characteristics “Believe they are invulnerable”

How do characteristics of adolescents affect my work? (1/2) Characteristics “Believe they are invulnerable” “Risk taking” Implications for HPV vaccine We may need to motivate the adolescent girl to get vaccinated" Engage in smoking, even though they have heard it is bad for health “Oriented on here and now, not on future” Fear of pain now may be far more immediate threat than cancer in 20 years “Influenced by peers” Be aware that “impressions” regarding vaccination - like fear of fainting or pain may spread very rapidly among adolescents 13 | Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

How do characteristics of adolescents affect my work? (2/2) Characteristics Implications for HPV vaccine

How do characteristics of adolescents affect my work? (2/2) Characteristics Implications for HPV vaccine “Don’t want to listen to parents” “Increasingly (feeling) independent” Adolescents may have a different opinion from parents on vaccination “Insecure” “Vulnerable” 14 | A young girl who missed school vaccination may feel shy to walk into a health facility. She will not be sure if she is allowed to, whether the health worker will give it to her, and if so what it will cost Girls who are disabled, or work as domestic workers are more at risk of early unprotected sex and exposure to HPV infection. Such vulnerable girls often have less access to HPV vaccination if health workers do not reach out to them Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

What should you do in this scenario? A 12 year old girl comes to

What should you do in this scenario? A 12 year old girl comes to the school on the first vaccination day. She clearly has the consent of the parents to be vaccinated, but when it is her turn to be vaccinated she refuses. What should you do? 15 | Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

What do I need to know and do differently if my patient is 13

What do I need to know and do differently if my patient is 13 and not 3 years old ? 16 | Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

What do I need to know and do differently if my patient is 13,

What do I need to know and do differently if my patient is 13, not 3 years old? 1. Establishing rapport 2. Taking a history of the presenting problem or concern 3. Going beyond the presenting problem or concern 4. Doing a physical examination 5. Communicating the diagnosis, explaining its implications and discussing the treatment options 6. Dealing with laws and policies that affect your work 7. Using the opportunity of the contact to inform, educate and, where possible, counsel 17 | Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

Prevention messages for cervical cancer to give to girls and boys l You can

Prevention messages for cervical cancer to give to girls and boys l You can protect yourselves against cervical cancer by getting vaccinated against HPV infections (girls aged 9 -13 years old) l Use condoms to prevent against unwanted pregnancy and sexually transmitted infections l Consider male circumcision to reduce the risk you and your partner get sexually transmitted infections (boys) l Do not start smoking or other forms of tobacco use, or stop tobacco use 18 | Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

Key messages l Adolescence is a special phase marked by rapid changes in physical,

Key messages l Adolescence is a special phase marked by rapid changes in physical, psychological and social development opportunity and risk l Adolescents have some characteristics that make them different from younger children and adults l Characteristics of adolescents may have implications for health related behaviours and for the way we provide health services, including vaccination l Need to take into account adolescents' evolving capacity, their growing desire for autonomy, and be aware of implications of their age for the informed consent process l When you develop a trusted relationship with an adolescent client, you can pass important prevention messages 19 | Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

End of module Thank you for your attention! 20 | Taking care of adolescent

End of module Thank you for your attention! 20 | Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020

References l Orientation programme on adolescent health for healthcare providers. WHO, 2006 l Adolescent

References l Orientation programme on adolescent health for healthcare providers. WHO, 2006 l Adolescent job aid. A handy desk reference tool for primary level health workers. WHO, 2010 21 | Taking care of adolescent patients, Module 7 Cervarix. TM | November 2020