GUIDANCE AND COUNSELLING FOR ADOLESCENTS

INTRODUCTION
Guidance and counselling are the twin concepts and have emerged as essential elements of every educational
activity. Guidance and counselling are not synonymous terms. Counselling is the part of guidance. Guidance
in the educational context, means to indicate, point out, show the way lead out and direct.
The basic function of guidance is to help individuals who need or seek assistance in varied problem facing
situations. the kind and amount of help provided by individual or groups depend upon their understanding of
the concept and guidance. Counselling is a specialized service of guidance. It is the process of helping
individuals learn more about themselves and their present and possible future situations to make a substantial
contribution to the society.
Adolescence is recognized as a phase rather than a fixed time period in an individual's life. It is a phase of
development and transformation from appearance of secondary sexual characteristics to sexual and
reproductive maturity; the transition from total socioeconomic and emotional dependence to relative
independence.
GUIDANCE
Definition
It is defined as the help given by one person to another in making choices and adjustments in solving
problems. (Jones)
Guidance is the process of helping every individual through his own efforts to discover and develop
his potentialities for his personal happiness and social usefulness. (Ruth Strang)
Guidance is a process through which an individual is able to solve their problems and pursue a path
suited to their abilities and aspirations. (J.M.Brewer)
Characteristics of guidance
 It is a continuous process from nursery school to adult education.
 It is pervasive.
 It is goal oriented.
 It is a coordinated effort.
 It is student centered.
COUNSELLING
Definition
It is the helping relationship that includes; someone seeking help, someone willing to give help, who
is capable or trained to help in a setting that permits help to be given and received. (Comier and Hackney)

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 Counselling is an accepting and trusting relationship and safe relationship in which client learns to
discuss freely what upsets them, to define their goals, to acquire the essential social skills and to develop the
courage and self-confidence to implement desired new behaviors. (Vedhanayagam)
Counselling is essentially a process in which the counselor assists the counselee to make
interpretations of facts relating to a choice, plan or adjustment which he needs to make. (Smith)
Characteristics
 It is a person to person relationship.
 It involves two individuals one seeking help and the other, a professionally trained person who can
help the first.
 A mutual relationship and respect, cooperation and friendliness established between the two
individuals.
 It is democratic.
Needs for guidance and counselling
 To help in the total development of the student.
 To help in proper choice of course.
 To help in proper choice of career.
 To help the student in vocational development.
 To develop readiness for choices and changes to face new challenges.
 To minimize the mismatching between education and employment and help in the efficient use of
manpower.
 To motivate the youth for self-employment.
 To help the fresher establish proper identity.
 To identify and motivate the students from weaker sections of the society.
 To help the students in their period of turmoil and confusion.
 To help in checking wastage and stagnation.
Counselling session
 Individual comes with concerns, problems, difficulties and certain stage confusion.

 All aspects of problem get discussed with due respect to the client.

 Counsellors assess the strengths and weakness of the individual based on the discussion.

 Counsellors can provide multiple alternative solution and help client to take the right decision or
solution.

 Counsellor facilitates the process as a neutral or non-judgmental person.

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 Counselling techniques
GATHER approach

G - Greet the  Put them at ease, show respect and trust.

adolescents  Emphasize the confidence nature of the discussion

A - Ask how can I  Ask how can I help you

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 their own words.
 Show respect and tolerance to what they say and do not pass judgment. Actively
listen and show that you are paying attention through your body language.
 Encourage them with helpful questions.

T - Tell them any  Provide accurate and specific information in reply to their questions.
relevant  Give information on what they can do to remain healthy.
information they  Explain any background information they need to know about the particular health
need issues.
 Keep the language simple, repeat important points and ask questions to check if
the important points are understood.
 Provide important information in the form of a leaflet if possible that they can
take away

H - Help them to  Explore various alternatives.

make decisions  Raise issues which they may not have thought of.
 Be careful of not letting your own views, values and prejudices influence the
advice you give.
 Ensure that it is their own decision and not the one you have imposed.
 Help them make a plan of action.
E - Explain any  Ask questions to check their understanding on important points.
misunderstanding  Ask the client to repeat the key points in their own words
s

R - Return for  Make arrangements for a follow-up visit or referral to other agencies.
follow-up or  If a follow-up visit is not necessary, give the name of someone they can contact
Referral for any need in future

Steps in counselling

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Step 1: Connect
 Initiate first contact
 Communicate appropriately
 Establish trust and confidentiality
Step 2: Reassure
 Be a calming influence
 Minimize feelings of insecurity
 Provide accurate information
 Refer to appropriate services
Step 3: stabilize
 Help clients understand their own reactions
 Recognize the signs of severe distress
 Refer to specialists if necessary
Step 4: Address needs and concerns
 Gather accurate information
 Clarify the client's concerns
 Formulate possible solutions to problems
 Provide practical assistance
Step 5: Provide support
 Help rebuild social networks
 Encourage clients to seek external support
 Assist in overcoming 'support obstacles'
Step 6: Facilitate Coping
 Raise awareness of positive coping skills
 Enable clients to identify negative coping
 Help clients to manage anger.
Difference Between Guidance and Counselling

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 Guidance Counselling
 It is a broad and comprehensive process.  It is more specific and intense in nature.
 It is an organized service to identify and  It is specialized service offered to help the individual
develop the potentialities of pupils. to solve the problems by them.
 It is preventive.  It is therapeutic.
 It can be given by any guidance worker.  It is given by specially trained professional.
 It can be given in any normal set-up.  It is given by special set-up.
 It operates at intellectual level.  It operates at emotional level.
 It may be required by all normal  It is required for the individual with problems.
individual.  It requires several sessions to grasp the individual’s
 It can be given in single meeting. situation in its totality.
 It has gained a status of profession.it is an artistic
 It’s not a profession. science and scientific art.
 It depends on the empathetic approach on the part of
 It does not require any approach on the counselor, not an emotional development.
part of counselor

GUIDANCE AND COUNSELLING FOR ADOLSCENTS

ADOLESCENTS
The percentage of adolescents (10-19 years) in India is increasing and comprises of one-fourth of the total
population.
During this phase of transition the adolescents face multi-complex issues such as gender discrimination, early
marriage and child bearing complications during pregnancy and childbirth. High risk of RTI/STI and
HIV/AIDS increases reproductive and sexual health complication which leads to higher maternal morbidity,
mortality and infant mortality rate. In addition, these conditions lead to discontinuation of school, restricted
exposure and reduced social interaction.
DEFINITION OF ADOLESCENT BY WHO
The World Health Organization (WHO) defines an adolescent as any person between ages 10 and 19. This
age range falls within WHO’s definition of young people, which refers to individuals between ages 10 and
24.
KEY FACTS ABOUT ADOLESCENTS BY WHO
 More than 1.1 million adolescents aged 10-19 years died in 2016, over 3000 every day, mostly from
preventable or treatable causes.

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  Road traffic injuries were the leading cause of death among adolescents in 2016. Other major causes
of adolescent deaths include suicide, interpersonal violence, HIV/AIDS and diarrheal diseases.
 Half of all mental health disorders in adulthood start by age 14, but most cases are undetected and
untreated.
 Globally, there are 44 births per 1000 to girls aged 15 to 19 per year.
NEED FOR COUNSELLING IN ADOLESCENTS
 Most of the adolescents are shy in nature and do not feel comfortable to disclose their doubt and
confusion to anybody due to lack of privacy, faith and confidentiality issues.
 often, they have lot of worries and anxiety, fear of exploitation, discrimination on the basis of age,
sex, gender, rural and urban, non-school going and school going, pregnant and non-pregnant etc.
 It is common among adolescents to have resistance for receiving help, feel embarrassed in seeking
health services. They are over reactive and impulsive.
 They are curious to know more about their physical, physiological and emotional changes. They do
not know where will they get appropriate and adequate information about their concerns, problems
and needs.
 Counselling provides assistance and guidance in resolving personal social and psychological
problems, difficulties and conditions. Counselling is an enabling process which empowers the
counselee to analyze his or her problems and find out a better option to solve it. The counselling is an
artful application of scientifically derived psychological knowledge and techniques for the purpose of
changing human behavior. The positive changes in the counselee may reflect in personal thinking,
feeling and finally his/her behavior or actions.
BASIC PRINCIPLES OF ADOLESCENT CENTERED COUNSELLING
 Adolescent centered issues, concerns and needs
 Acknowledge fundamental rights of adolescents
 Respect and accept their concerns
 Offer non-directive suggestions
 Non-judgmental
 Provide them resources and problem-solving skills
MAIN HEALTH ISSUES
Injuries
Unintentional injuries are the leading cause of death and disability among adolescents. In 2016, over 135 000
adolescents died as a result of road traffic accidents. Many of those who died were “vulnerable road users”,
including pedestrians, cyclists or users of motorized two-wheelers. In many countries, road safety laws need
to be made more comprehensive, and enforcement of such laws needs to be strengthened.
Furthermore, young drivers need advice on driving safely, while laws that prohibit driving under the
influence of alcohol and drugs need to be strictly enforced among all age groups. Blood alcohol levels should

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be set lower for young drivers than for adults. Graduated licenses for novice drivers with zero-tolerance for
drink-driving are recommended.

Mental health
Depression is one of the leading causes of illness and disability among adolescents, and suicide is the second
leading cause of death in adolescents. Violence, poverty, humiliation and feeling devalued can increase the
risk of developing mental health problems.
Building life skills in children and adolescents and providing them with psychosocial support in schools and
other community settings can help promote good mental health.

Violence
Interpersonal violence is the third leading cause of death in adolescents, globally, though its prominence
varies substantially by world region. It causes nearly a third of all adolescent male deaths in low- and middle-
income countries of the WHO Region of the Americas. Globally, nearly one in three adolescent girls aged 15
– 19 years (84 million) has been a victim of emotional, physical and/or sexual violence perpetrated by their
husband or partner.
HIV/AIDS
An estimated 2.1 million adolescents were living with HIV in 2016; the great majority in the WHO African
Region. However, a substantial proportion of HIV-positive adolescents are unaware of their status, and many
of those who are aware of their status do not receive effective, long-term antiretroviral treatment.
Young people need to know how to protect themselves from HIV infection and must have the means to do
so. Better access to HIV testing and counselling, and stronger subsequent links to HIV treatment services for
those who test HIV positive, are also needed.
Other infectious diseases
Diarrhea and lower respiratory tract infections are estimated to be among the top 10 causes of death for 10–
19-year-old. These two diseases, along with meningitis, are all among the top five causes of adolescent death
in African low- and middle-income countries.
Early pregnancy and childbirth
The leading cause of death for 15-19-year-old girls globally is complications from pregnancy and childbirth.
Some 11% of all births worldwide are to girls aged 15–19 years, and the vast majority of these births are in
low- and middle-income countries.
Better access to contraceptive information and services can reduce the number of girls becoming pregnant
and giving birth at too young an age. Laws that are enforced that specify a minimum age of marriage at 18
can help.
Girls who do become pregnant need access to quality antenatal care. Where permitted by law, adolescents
who opt to terminate their pregnancies should have access to safe abortion.

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Alcohol and drugs
Harmful drinking among adolescents is a major concern in many countries. It reduces self-control and
increases risky behaviors, such as unsafe sex or dangerous driving. It is an underlying cause of injuries
(including those due to road traffic accidents), violence and premature deaths. It can also lead to health
problems in later life and affects life expectancy. Setting a minimum age for buying and consuming alcohol
and regulating how alcoholic drinks are targeted at the younger market are among the strategies for reducing
harmful drinking.
Drug use among 15–19-year-old is also an important global concern. Drug control may focus on reducing
drug demand, drug supply, or both, and successful programmes usually include structural, community, and
individual-level interventions.
Nutrition and micronutrient deficiencies
Iron deficiency anemia was the second leading cause of years lost by adolescents to death and disability in
2016. Iron and folic acid supplements are a solution that also helps to promote health before adolescents
become parents. Regular deworming in areas where intestinal helminths such as hookworm are common is
recommended to prevent micronutrient (including iron) deficiencies.
Developing healthy eating habits in adolescence are foundations for good health in adulthood. Reducing the
marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt and providing access to healthy
foods are important for all, but especially for children and adolescents.
Undernutrition and obesity
Many boys and girls in developing countries enter adolescence undernourished, making them more
vulnerable to disease and early death. At the other end of the spectrum, the number of adolescents who are
overweight or obese is increasing in low-, middle- and high-income countries.
Physical activity
Physical activity provides fundamental health benefits for adolescents, including improved cardiorespiratory
and muscular fitness, bone health, maintenance of a healthy body weight, and psychosocial benefits. WHO
recommends for adolescents to accumulate at least 60 minutes of moderate- to vigorous-intensity physical
activity daily, which may include play, games, sports, but also activity for transportation (such as cycling and
walking), or physical education.
Tobacco use
The vast majority of people using tobacco today began doing so when they were adolescents. Prohibiting the
sale of tobacco products to minors (under 18 years) and increasing the price of tobacco products through
higher taxes, banning tobacco advertising and ensuring smoke-free environments are crucial. Globally, at
least 1 in 10 adolescents aged 13 to 15 years uses tobacco, although there are areas where this figure is much
higher. Cigarette smoking seems to be decreasing among younger adolescents in some high-income
countries.

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 COUNSELLING ASPECTS

Reproductive health
 Genital hygiene for boys
 Hygiene and cleanliness for girls
Nutrition
Sexual health
 Preventing unintended pregnancy
 Strategies to avoid, HIV-AIDS

COUNSELLING
ASPECTS
Mental health
 Stress
Non-communicable diseases  Depression
 Substance abuse
 Alcohol abuse
 Tobacco abuse
 Suicide

Reproductive health
Most of the changes in reproductive organs and body are generally normal and same across the adolescence.
However, if adolescent find something structurally abnormal, they should be referred to a medical officer or
get helped on phone by the health providers.
Genital hygiene for boys:
 Wash genitals daily.
 Gently retract (push) foreskin back and wash the tip of the penis.
 Secretions accumulate under the foreskin and could cause infection if not cleaned regularly.
 Change underwear daily.
 Use cotton undergarments only. Synthetic garments do not absorb moisture and also increase
the temperature.
 Undergarments should be washed and sun-dried regularly.
Counsel to improve the skills of all girls about the importance of reproductive hygiene and basic
physiological steps of menstrual cycle.

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 Hygiene and cleanliness during menstruation
 To maintain menstrual hygiene, girls can either use soft cotton cloth or sanitary pads.
Cotton has good absorbing capacity.
 A synthetic cloth should not be used as it may not absorb well and may cause skin reactions.
If the girl can afford to buy pads, she can use them. Cloth /pads can be used along with the
underwear.
 The cloth or pads should be changed 2 or 3 times a day. The cloth and panties should be
properly washed with soap and water and dried in the sun. Sunlight kills all the bacteria.
 After every usage, the cloth should be washed, dried and stored in a clean bag. ·
 If pads are used, they should be wrapped in a paper bag and disposed. The girl should take
a bath every day during menstruation.
 There is no need to clip/ wax pubic hair as routine just for the sake of hygiene. These days
there is a lot of advertisement about perianal washes, antiseptic soaps, deodorants, etc. but
remember the best way to maintain hygiene is regular cleaning and washing of the local
parts with plain water without any antiseptics.
Sexual health
The influence of western culture through the visual media has changed the social pattern in urban as well as
semi urban areas of our country. In rural areas also the impact of these changes is slowly becoming evident.
Due to various physiological hormonal influences, sexual functions and sexuality become a very important
part of adolescence.
In India an adolescent girl is forced to enter into sexuality when married below the age of 16 years. Many of
them become mothers below the age of 18 years. This practice puts the health of young girls at a high risk.
With permissiveness and premarital sex, the unmarried teenage pregnancies are also increasing in India.
Since the subject of adolescent sexuality remains taboo in most societies, there is a widespread ignorance
among young people about the risk associated with unprotected sexual activity. Sources of information and
contraceptive advices are rarely available or accessible to them.
There is a very high chance that such risky behavior will lead to multiple reproductive health problems. In
the short term the adolescent might pick up a sexually transmitted infection such as gonorrhea (which is
curable if treated). However, they also carry the risk of getting infected by HIV and this is not curable,
although it can be treated to slow the progression of the disease to full blown AIDS. If the girl also becomes
pregnant there is a risk of transmitting the infection to the baby, which is likely to be born undernourished
and prematurely. These are long-term problems which are likely to be passed on to the next generation.
Inform that sex urges are perfectly normal at this age but one should stay in control of these feelings in view
of possible risks of unprotected sex.
“Sexuality counselling” refers to the counselling on issues related to one or more aspects of sexuality with
the aim of understanding the underlying features of clients' sexual lives and how that affects their sexual and
reproductive health.

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  General counseling.
 Counsel children and parents about normal sexual development before the onset of sexual activity,
and encourage parent-child communication about sexuality.
 Parents should be encouraged to discuss explicit expectations for abstinence, for delaying sexual
activity, and for responsible expression of one’s sexuality.
 Advise children and adolescents to discontinue high-risk sexual behavior and avoid or discontinue
coercive relationships.
 Discourage alcohol and other drug use and abuse not only for the direct benefits to the adolescent’s
health but also to prevent unwanted sexual activity or adverse consequences of sexual activity.
 Handouts to reinforce safe sex practices and responsible decision-making should be made available in
the clinic.
Preventing unintended pregnancy.
 Discuss methods of birth control with male and female adolescents ideally before the onset of sexual
intercourse.
 Barrier methods should always be used during intercourse in combination with spermicide or with
hormonal contraceptives.
 Providing access to contraception for adolescents who are sexually active is an important method of
reducing pregnancy rates.
Strategies to avoid STDs, including HIV infection and AIDS.
 Abstinence should be promoted as the most effective strategy for preventing HIV infection and other
STDs as well as for prevention of pregnancy.
 Adolescents who become sexually active need additional advice and health care services.
 Adolescents should be counseled regarding the importance of consistent use of safer sex precautions.
 Maintaining proper genital hygiene is important
 Girls should maintain good menstrual hygiene
 Practicing responsible sexual behavior. Being faithful to one partner
 Practicing safe sex
 Avoiding sexual contact, if either of the partner has an STI
 Do not neglect any unusual discharge
 Ensuring complete treatment of self and sexual partner
Nutrition
Healthy diet can help teenager to look good and stay healthy:

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Eating breakfast: Skipping breakfast does not help in losing weight, because essential nutrients might be
missed out. A healthy breakfast is an important part of a balanced diet and provides some of the vitamins and
minerals required for good health. Whole grain cereal with fruit sliced over the top is a tasty and healthy way
to start the day.
Aim to eat fruits and vegetables a day: Fruits and vegetables are sources of most of the vitamins and
minerals which is essential for the body. Fresh fruit juice, smoothies and vegetables can help in balanced
diet.
At snack time, substitute foods that are high in saturated fat or sugars for healthier choices: Foods high
in saturated fat include pies, processed meats such as sausages, biscuits and crisps. Foods high in added
sugars include cakes and pastries, sweets, and chocolate. Too much saturated fat can also cause high
cholesterol.
Drink enough fluids: One should aim to drink at least six to eight glasses of fluids a day, water,
unsweetened fruit juices (diluted with water) and milk are all healthy choices.
Eating healthy food: Foods such as whole meal bread, beans, wholegrain breakfast cereals, fruit and
vegetables. Such kind of foods are high in fibre are bulky and help us feel full for longer time.
Being Underweight: Not eating a balanced diet or restricting food intake can lead to deficiency of important
nutrients in the body.
This can lead to weight loss. Being underweight can cause health problems, so if adolescents are underweight
it’s important to gain weight but in a healthy way.
Being Overweight: Foods rich in fat and sugar are high in calories, or eating too many calories can lead to
weight gain. Try to eat lesser foods that are high in fat and sugar, such as swapping to low or no sugar fizzy
drinks. A healthy balanced diet will provide you with all the nutrients your body needs.
Non-communicable Diseases

 Counsellors should promote healthy practices by suggesting easily available and doable activities. It
motivates the clients to initiate healthy practices immediately without any external support.
 Counsellors have to focus on health promotion, preventive measure and referral. Refer the case for
medical consultation. One of the important roles of the counsellors is that they not only have to refer
but also help client to reach at appropriate service provider. (Counsellors can ensure the appointment
by phone or provide brief background about client to the providers)
 In case of confusion and doubt counsellors can discuss the issue on phone with health provider before
advising it to the clients.
 Counsellors should know the local language, culture and custom so that they can provide acceptable
suggestions and advices.
Mental Health
Stress
Counsel the adolescents about the following;

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  Be assertive instead of aggressive. Assert their feelings, opinions, or beliefs instead of becoming
angry or defensive.
 Learn and practice relaxation techniques; try meditation and yoga for stress management.
 Exercise regularly. Their body can fight stress better when it is fit.
 Eat healthy, well-balanced meals.
 Set limits appropriately and learn to say no to requests that would create excessive stress in your life.
 Make time for hobbies, interests and relaxation.
 Get enough rest and sleep. Their body needs time to recover from stressful events.
 Seek out social support.
 Seek treatment with a psychologist or other mental health professional trained in stress management
or biofeedback techniques to learn healthy ways of dealing with the stress in your life.

Depression
 Encourage your client chose healthy food and drinks.
 Get your client to participate in regular physical activity. Staying physically active can help improve
mental health. It might be as simple as taking a walk every day to start with.
 Advice your client to get enough sleep.
 Try to counsel parents about reducing family conflicts as much as possible.
 Counsel client and parents about avoiding alcohol and other drugs, as it can worsen the situation.
 Advice the client to engage in constructive things which entertains and relaxes him/her.
 If the client has trouble talking about feelings, suggest a diary/ journal writing. Sometimes it's easier
to write down things than to say them aloud.
 Suggest some other people the client could talk to if he/she doesn't want to talk to his/her parents –
for example, aunts or uncles, close family friends, a trusted teacher or religious leader, or a family
doctor.
 Encourage the client to let the Counselor or any adult know if he/she thinks things are getting worse.
 Accept that there will be good and bad days.
Substance abuse
Substance abuse, also known as drug abuse, is a regular use of a substance (drug) in which the user consumes
the substance in amounts or with methods which are harmful to themselves or others. The term "drug abuse"
does not exclude dependency, but is otherwise used in a similar manner in non-medical contexts. This section
will elaborate on substances like, alcohol, tobacco and drugs like cannabinoids and depressants.
Alcohol abuse: Alcohol abuse creates serious social, medical and behavioral problems among the
adolescents.
 Build rapport and confidence with the client.
 Explain about ill effects of alcohol on health.
 Try to find out factors responsible for adopting such behavior.

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  Offer help and support if client wishes to give up the habit.
 Allow the client to make the choice of quitting alcohol/ drug abuse.
 Suggest options for rehabilitation centers /support groups that can help in overcoming the habit.
Tobacco Abuse: The amount absorbed by the body is dependent on various factors such as form of tobacco,
quantity and frequency. The common health risk associated with tobacco use are cancers, cardiovascular
diseases, stroke, stillbirth, complication in pregnancy, ulcers, COPD, increased frequency of asthma,
common cold and cough.
 Set a good example: Adolescents whose parents smoke are more prone to adopting the habit of
smoking.
 Understand the attraction: Adolescent smoking can be a form of rebelliousness or a way to fit in with
a particular group of friends or to feel cool or independent.
 Say no to adolescent's smoking: Tell the adolescent that smoking isn't allowed. The disapproval will
have more impact than they think.
 Appeal to the adolescent's vanity: Smoking isn't glamorous. Remind the adolescent that smoking is
dirty and smelly. Smoking gives bad breath and wrinkles. Smoking makes the clothes and hair smell,
and it turns your teeth yellow.
 Tell smoking is expensive: Help the adolescent calculate the weekly, monthly or yearly cost of
smoking a pack a day.
 Expect peer pressure: Friends who smoke can be convincing, but encourage to refuse cigarettes.
 Take addiction seriously: Most adolescents believe occasional smoking won't cause them to become
addicted and that, if they become regular smokers, they can stop smoking anytime they want.
 Predict the future: Most adolescents think cancer; heart attacks and strokes occur only to other
people. Use loved ones, friends, neighbors or celebrities who've been ill as real-life examples.
 Think beyond cigarettes: Smokeless tobaccos are sometimes mistaken as less harmful or addictive
than are traditional cigarettes. Nothing could be further from the truth. Don't let the adolescent be
fooled.
 Get involved: Take an active stance against adolescent smoking. Participate in local and school
sponsored smoking prevention campaigns.
Suicide: Adolescent may commit suicide as an unusual act in conditions like sudden adverse events
(academic failure, death of close relation), being a victim of bullying or abuse or sexual problems. The long-
term anxiety or depressive disorders may trigger suicidal tendencies among adolescents. The symptoms
(warning signs) indicate that the individual might be going towards suicidal behavior
On observing the symptoms, counsellor should talk to client's relatives/friends about
 Taking the client seriously.
 Not leaving the client alone.
 Listening to the client and allowing him/her to express himself and herself.
 Identifying the trigger event and helping the client overcome it.
 Ensuring that the client stays around with people he/she feels comfortable with.
 Referring to health personnel.
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Parent's support can have a direct and positive impact on adolescent's mental health. Here are some ideas for
parents to promote mental health and wellbeing of an adolescent:
 Show love, affection and care towards all your children equally.
 Show that as a parent you are interested in what is happening in your child's life. Praise his strengths
and achievements. Give value to his/her ideas.
 Deal with problems as they arise, rather than letting them build up.
 Talk to family members, friends, other parents or teachers if you have any concerns. If you feel you
need more help, speak to your General Practitioner or another health professional.
 If parents notice any of the below warning sign amongst adolescents, they should seek advice
counsellors or Health professional advice.
 Seeming down, feeling things are hopeless, being tearful or lacking motivation
 Having trouble coping with everyday activities
 Showing sudden changes in behavior, often for no obvious reason.
 Having trouble eating or sleeping
 Dropping school performance, or suddenly refusing to go to school
 Avoiding friends or social contact
 Making comments about physical pain (for example, headache, stomach ache or backache)
 Being aggressive or antisocial – for example, missing school or stealing
 Being very anxious about weight or physical appearance, weight loss, or failing to gain weight
as he/she grows.
 Be there for your child. Encourage your child to talk about his/her feelings with you. It's important for
your child to feel he/she doesn't have to go through things on his/her own alone and that you can
work together to find solutions to the problems
ADOLESCENT HEALTH and WHO
In May 2014, WHO published a major report called “Health for the world’s adolescents”. The report
analyses what is known about adolescents’ health, including what promotes or undermines it, highlights gaps
in policies and services, and draws together guidance and recommendations from across WHO. The report,
which focuses on the health sector, examines areas of significant improvements and innovative approaches.
WHO also provides technical advice to the UN Secretary General’s Global Strategy for Women’s, Children’s
and Adolescents’ Health, and is working with other UN agencies and partners to develop a Global
Accelerated Action for the Health of Adolescents (AA-HA!) Framework, which will aim to help countries
to decide what to do in adolescent health and how to do it.
Strategies
1. Understanding what is special about adolescents and why investing in them results in long-term
societal benefits.
2. Understanding global and regional adolescent health profiles.

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 3. Understanding what works – the AA-HA! package of evidence-based interventions.
4. Understanding the country’s adolescent health profile Undertaking landscape analysis Conducting a
consultative process for setting priorities based on explicit criteria.
5. Planning and implementing national programmes.
6. Strengthening accountability for adolescent health: - monitoring and evaluating adolescent health
programmes; - priorities for adolescent health research
Overall, WHO carries out a range of functions to improve the health of young people, including:
 Production of evidence-based guidelines to support health services and other sectors;
 Making recommendations to governments on adolescent health and the provision of high quality,
age-appropriate health services for adolescents;
 Raising awareness of health issues for young people among the general public and special groups.
ADOLESCENT HEALTH and INDIA
There are 253 million adolescents in the age group 10-19 years in India. This age group comprises of
individuals in a transient phase of life requiring nutrition, education, counseling and guidance to ensure their
development into healthy adults. They are susceptible to several preventable and treatable health problems,
like early & unintended pregnancy, unsafe sex leading to STI/HIV/AIDS, nutritional disorders like
malnutrition, anemia & overweight, alcohol, tobacco and drug abuse, mental health concerns, injuries
&violence.
Rashtriya Kishor Swasthya Karyakram (RKSK)
In order to ensure holistic development of adolescent population, the Ministry of Health and Family Welfare
launched Rashtriya Kishor Swasthya Karyakram (RKSK) on 7th January 2014 to reach out to 253 million
adolescents - male and female, rural and urban, married and unmarried, in and out-of-school adolescents with
special focus on marginalized and undeserved groups.
The programme expands the scope of adolescent health programming in India - from being limited to sexual
and reproductive health, it now includes in its ambit nutrition, injuries and violence (including gender-based
violence), non-communicable diseases, mental health and substance misuse.
Scheme for Promotion of Menstrual Hygiene among Adolescent Girls in Rural India
The scheme aims at ensuring that adolescent girls in the target group have adequate knowledge and
information about menstrual hygiene and the use of sanitary napkins, that high quality, safe products are
made available to them, and that environmentally safe disposal mechanisms are readily accessible. The
scheme has been launched as part of the Adolescent Reproductive and Sexual Health (ARSH) component
under RCH II.
Procurement of sanitary napkins, whether through Central supply by the Government of India, or through
SHGs, has to be done at a fixed price of Rs. 7.50/- per pack of six sanitary napkins. The sanitary napkins are

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provided under NHM’s brand, ‘Freedays’. These napkins are being sold to adolescents girls at the rate of
Rs. 6 per pack of six napkins by Accredited Social Health Activists (ASHAs). From out of the sale proceeds,
the ASHA gets an incentive amount of Re. 1 per pack, besides getting a free pack of sanitary napkins per
month and the balance Rs 5 is to be deposited in the State/district treasury.

Weekly Iron and Folic Acid Supplementation (WIFS) Programme

WIFS Program is to meet the challenge of high prevalence and incidence of anemia amongst adolescent girls
and boys. WIFS is evidence based programmatic response to the prevailing anemia situation amongst
adolescent girls and boys through supervised weekly ingestion of IFA supplementation and biannual
helminthic control. The long-term goal is to break the intergenerational cycle of anemia, the short-term
benefits is of a nutritionally improved human capital. The programme, implemented across the country both
in rural and urban areas.
Salient features of WIFS
Objective of WIFS: To reduce the prevalence and severity of anemia in adolescent population (10-19 years).
Target groups:
 School going adolescent girls and boys in 6th to 12th class enrolled in government/government
aided/municipal schools.
 Out of school adolescent girls.
Intervention:
 Administration of supervised Weekly Iron-folic Acid Supplements of 100mg elemental iron and
500ug Folic acid using a fixed day approach.
 Screening of target groups for moderate/severe anemia and referring these cases to an appropriate
health facility.
 Biannual de-worming (Albendazole 400mg), six months apart, for control of helminthic infestation.
 Information and counselling for improving dietary intake and for taking actions for prevention of
intestinal worm infestation.
Convergence: Convergence with key stakeholder ministries like the Ministry of Women and Child
Development and Ministry of Human Resource Development is an essential part of implantation plan of the
WIFS programme
AFHC – Adolescent Friendly Health Clinics: Through Adolescent Friendly Health Clinics (AFHCs),
counselling and curative services are provided at primary, secondary and tertiary levels of care on fixed days
and fixed time with due referral linkages. Commodities such as Iron & Folic Acid tablets and non-clinical

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contraceptives are also made available in the clinics for the adolescents. Capacity building of service
providers in the six thematic areas is vital for effective and successful implementation of RKSK
Counselling services for adolescent on important health areas such as nutrition, puberty, RTI/STI prevention
and contraception and delaying marriage and child bearing are being provided through recruitment and
training of dedicated counsellors.
Commodities available at AFHC 
 Weekly Iron & Folic Acid Supplementation & Albendazole
 Sanitary napkins
 Contraceptives
 Medicines
Information (IEC & IPC) at AFHC
 Counselling on nutrition, menstrual disorders, personal hygiene, menstrual hygiene, use of sanitary
napkins, use of contraceptives, sexual concerns, depression, sexual abuse, gender violence, substance
misuse and promoting healthy behavior to prevent non-communicable diseases
 Posters/booklets/pamphlets, wall writing and visuals.
The Ministry of Women and Child Development, Government of India, in the year 2000 came up with
scheme called “Kishori Shakti Yojna” (KSY) using the infrastructure of Integrated Child Development
Services (ICDS). The objectives of the Scheme were to improve the nutritional and health status of girls in
the age group of 11-18 years as well as to equip them to improve and upgrade their home-based and
vocational skills; and to promote their overall development including awareness about their health, personal
hygiene, nutrition, family welfare and management. The scheme provided for Rs.1.1 lakh per project per
annum. 2-3 AGs per AWC are targeted under this scheme who are also provided supplementary nutrition by
the state governments.
Thereafter, Nutrition Programme for Adolescent Girls (NPAG) was initiated as a pilot project in the year
2002-03 in 51 identified districts across the country to address the problem of under-nutrition among
adolescent girls. Under the programme, 6 kg of free food grains per beneficiary per month are given to
underweight adolescent girls.
The above two schemes have influenced the lives of AGs to some extent, but have not shown the desired
impact. Moreover, the above two schemes had limited financial assistance and coverage besides having
similar interventions and catered to more or less the same target groups.
A need has therefore, emerged to formulate a new comprehensive scheme with richer content, merging the
erstwhile two schemes that would address the multi-dimensional problems of AGs. This Scheme shall be
called Rajiv Gandhi Scheme for Empowerment of Adolescent Girls (RGSEAG) --“SABLA”. It would
replace KSY and NPAG in the 200 selected districts. KSY would be continued (where operational) in

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remaining districts. 6. Rajiv Gandhi Scheme for Empowerment of Adolescent Girls - SABLA - would be
implemented using the platform of ICDS Scheme through Anganwadi Centers (AWCs).
The objectives of the Scheme are;
 Enable the AGs for self-development and empowerment.
 Improve their nutrition and health status.
 Promote awareness about health, hygiene, nutrition, Adolescent Reproductive and Sexual Health
(ARSH) and family and child care.
 Upgrade their home-based skills, life skills and tie up with National Skill Development Program
(NSDP) for vocational skills.
 Mainstream out of school AGs into formal/non-formal education vi. Provide information/guidance
about existing public services such as PHC, CHC, Post Office, Bank, Police Station, etc.
CONCLUSION
Most adolescents are thriving, but many engage in risky behavior, develop unhealthful habits, and experience
physical and mental health conditions that can jeopardize their immediate health and contribute to poor
health in adulthood.
JOURNAL REFERENCE
Title: What Adolescent Girls Know about Mental Health: Findings from a Mental Health Literacy Survey
from an Urban Slum Setting in India.
Authors: Saraf G, Chandra PS, Desai G, Rao GN
Youth in vulnerable situations are known to have high rates of mental disorders but low help-seeking. Help-
seeking is known to be influenced by mental health literacy (MHL), a key concept that is important for the
recognition of mental disorders and planning intervention.
Aims:
To explore MHL and help-seeking patterns in a group of young women in an urban slum setting in India.
Materials and methods:
A total of 337 young women between 16 and 19 years of age belonging to urban slum settings formed the
study sample. Two vignettes on depression and self-harm were used to assess: (a) recognition of the disorder,
(b) help-seeking, and (c) knowledge of treatments available.
RESULTS:
Only 8% of women were able to label the condition as depression in the first vignette. Though suicidality
was identified correctly by the majority of participants 73 (63%), they did not think it needed urgent
intervention. Only a few considered mental health professionals as possible sources of help (19.3% for

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depression and 2.4% for self-harm). Majority of the young women felt friends and parents were sources of
help, and that stigma and lack of awareness were the reasons for not considering professional help.
Conclusion:
MHL regarding depression and suicidality is low among young women from low-income areas. It is a critical
and urgent need to encourage early and appropriate help-seeking for mental health problems in this
vulnerable population.

BIBLIOGRAPHY
1. Kishore J. National health programs of India. 12thed. New Delhi: Century Publications; 2017.
p164-70
2. Park K. Textbook of preventive and social medicine. 24ed. Jabalpur. Banarsidas Bhanot; 2017.
p485-6
3. Saraf G, Chandra PS, Desai G, Rao GN. What Adolescent Girls Know about Mental Health: Findings
from a Mental Health Literacy Survey from an Urban Slum Setting in India. Indian J Psychol Med.
2018; 40:433-439.
4. Adolescent health and WHO [ Retrieved from: https://www.who.int/topics/adolescent_health/en/]
5. Adolescent health and India. [Retrieved from: http://nhm.gov.in/nrhmcomponnets/reproductive-child-
health/adolescent-health/]
6. Sudha R. Nursing education principles and concepts. New Delhi: Jaypee;2013. p310-5,321-3
7. SABLA SCHEME [Retrieved from: http://wcd.nic.in/sites/default/files/1-SABLAscheme_0.pdf]

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