Interactive lectures

Group discussion on articles 1, 2

Lecture theme: Review the ‘functions’ of experimentation during adolescence and discuss the resulting increased possibilities for risk behaviours to become established habits. Use the following questions to illustrate some of the processes at work.

• How many adult smokers started their habit before age 20?
• What is the average age in your country for first sexual intercourse?
• What is the percentage of overweight adolescents who become obese adults?
• What is the trend over the last 10 years of cannabis use among adolescents in the countries represented?

Modules A1, C1, A6

Refs 1, 2

Module A5

Ref 3

A.  Explore theories of health behaviour and the factors that influence these behaviours in different settings

• social learning theory
• Prochaska’s stages of change
• Antonovski’s sense of coherence
• Salutogenesis and the Ottawa charter

Minilecture

Readings

Group Discussion

B.Understand, and integrate with an understanding of adolescent development, the concepts of:

• anticipatory guidance
• primary/secondary/tertiary prevention
• health education
• health promotion
• community health

Participants give concrete examples of interventions (on the individual, family, school, community, and country-based levels) that represent each concept.

List subjects and areas for interventions that would be relevant during each of the three phases of adolescence- early, middle and late adolescence. What would be an example of designing a preventive approach in a ‘developmentally appropriate’ way?  (Suggestion: use theme of obesity, and concept of primary prevention)

Minilecture

Readings

Group Discussion

Lecture themes: Review the concepts of efficacy, efficiency and effectiveness of preventive interventions. Distinguish between the terms ‘process’ and ‘outcome’ evaluation. Provide an overview of the literature on the evaluation of preventive and health promotion programs for:

• mental health & suicide
• substance use
• sexual behaviour
• cardio-vascular disease
• injuries, etc.

Compare the effectiveness of interventions aimed at changing behaviours to those targeting the modification of the environment, using examples such as teaching healthy eating behaviours versus banning sweets and soft drinks sales within schools.

Find examples of effective legal actions such as the prohibition of the sale of tobacco to those under age 18.

Discuss the importance of involving parents and families in a health prevention/promotion strategy.

Module C1

Refs 9, 13 - 17

A. Understand the effective approaches to using each patient encounter for health promotion and prevention

• building the communication bridge
• motivational interviewing
• short interventions
• solution focused approaches

Interactive lecture

Group discussion

Group Work

Plenary discussion

Video

List the topics that are amenable to prevention within an interview/consultation with an adolescent. How can the health provider assess if promotion or prevention is needed?
Discuss the usefulness of screening instruments (esp. HEADSS), and when/how to introduce them.
Additional issues:

• Give examples of issues which may not arise spontaneously (“hidden agenda”).
• What are effective ways of integrating advice into a patient encounter?
• What are the reasons that certain kinds of advice or style of advice works with teenagers?

Module A3

Refs 18 - 20

Have participants share examples of small or large changes they instigated in an adolescent’s environment (home, school, work), which have had an impact on that one patient’s health and well-being (examples: calling the school nurse, having a family meeting).

Given that a negative financial situation can influence an adolescent’s health and lifestyle, what options does a health provider have to address or modify this ‘environmental’ factor?

C. Provide effective, developmentally appropriate advice to an adolescent on an individual basis and in a family counselling setting

• guidelines for each developmental stage-objectives of an advice
• giving session
• expectations of parents
• family dynamics

Group work with role play or simulated patients video

Family interview

Role play

Video of successful counselling approach

Groups practice giving advice on the following subjects, first targeted to the adolescent and then to parents of the adolescent. Discuss what is particular to each of the three developmental stages (early, middle, and late adolescence).

• injury prevention
• sports activity
• nutrition
• substance use
• sexuality

Variation of role play: inject a negative emotional element, such as the parents are alarmed about their child’s use of substances or about their child’s sexual behaviour.  What information about the parents’ parenting style or values would be helpful to obtain?

Modules A2, A3

Refs 18 - 20

D. Describe the concept of Health Promoting Schools and how it is effective in reducing specific problems of adolescence

• school climate
• peer-teacher relationships
• active student participation
• equity in education and health

Minilecture and discussion

Review of research on Health Promoting Schools

E. Consider how to capitalize on the range of possibilities to offer health promotion and prevention in the school setting

• health education integrated in all grades/subjects
• targeted prevention programming or strategies(for a specific health problem or risk)

Invite teachers to the session and discuss with them how they could address health issues within their own courses (math, readings, biology, etc.)

Review current strategies implemented in the school setting to reduce problems such as substance misuse, unplanned pregnancy, deviant behaviour, obesity and abnormal eating patterns. What appears to account for the success or failure of any of the targeted programs? Discuss the importance of strategies that are long-term and tailored to the developmental age of each school level.

F. Consider the methods of involving young people in their own health promotion and prevention strategies within the school structure

• identification of the students’ priorities and acceptable strategies
• peer leadership, peer counselling or tutoring
• recruitment, training, and supervision issues

G. Understand how the community setting offers possibilities for health promotion and prevention

• concept of community health
• professionals usually involved in c.h.
• effect of ‘social marketing’ on young people

H. Consider specific strategies to involve young people in community health

• peer-group intervention
• youth councils
• participation of young people in interventions

Lecture

Readings Field & group work

Feedback by experts

Lecture introduce the basic principles of ‘social marketing’.

Which strategies to improve the health and well being of teenagers are particularly suitable for a community level effort (e.g. violence prevention)? Participants talk about the problems in their home communities and whether there have been effective responses that impact the lives of the adolescents (e.g. safe streets).

Discuss various forms of lobbying and advocacy strategies that a health provider might engage in. Give concrete examples in the subject areas affecting adolescence.

Refs 9, 24, 32 - 35

Refs 5, 12, 17, 21, 24, 36

A. Follow the steps involved in selecting an intervention

1. In a given setting, identify the needs and problems of young people, based on available data.
2. Select priorities which need intervention
3. Identify the stake-holders who have an interest in preventive activities, and involve them in the selection process

Group discussions

Surveying young people

Data collection

Focus groups

Delphi survey

Questions to address:

• Do specific subgroups of adolescents have special needs?
• How do you assess these needs? What are the sources of data available and how could you collect data (survey, focus group etc.) that could help in the prioritising?
• How would you set priorities for interventions?
  Describe how young people, including minorities and subgroups, may be involved in this process.

List the probable groups which would have an interest in a health promotion/prevention intervention for adolescents (e.g. the parent-teacher association)

Refs 24, 32, 37, 38

Module C1

B. Follow the steps involved in designing an intervention

1. Set specific measurable objectives
2. Choose the appropriate design for intervention
3. Identify professionals to be involved in running the program
4. Identify existing resources, technical and human
5. Chose appropriate evaluation methods and tools
6. Make a budget and design a timeframe
7. Get the money

Group discussions

Meet with experts

Exchange ideas with professionals involved in specific programs

On-site visit of successful programs

Programme fair (stands exhibiting various experiences and programmes,Round-table with presentation of interventions)

Considerations for the planning process:

• In planning an intervention, focus on obstacles and resources.
• Discuss the pros and cons of various designs / approaches. Should it be educational? Specific or non-specific? Focus on health promotion and/or on the prevention of specific problems?
• What kind of information will be needed to answer the question “Did the program meet its objectives?” How will you collect this data? What will be the criteria for ‘success’?
• How do you identify potential sponsors and convince them to support the project?

Identify in the participants’ own countries/regions various financial and other resources, e.g.

• state authorities
• national/international NGO’s
• private foundations
• industries

Discuss how to respond to program opponents:

• Decision makers may feel that adolescents are in good health and don’t need resources.
• “Adolescents would not participate anyway.”
• “The money should rather go to the increasing population of aged people.”

Refs 24, 32, 37, 38

Ref 39

C. Demonstrate ability to implement the intervention

1. Identify training needs of those who run the intervention and train them
2. Prepare the materials needed
3. Pre-test the intervention
4. Reframe and run the program

Meet with those who will participate in the intervention.
Assess their competence and needs. Discuss and develop the needed materials with these people.

Important issues to discuss:

• how to sensitise the community to the intervention
• how to recruit professionals involved in the process
• how to collaborate with young people
• how to develop the appropriate tools (questionnaires, pamphlets, educational material)

D. Perform an evaluation

1. Select appropriate indicators (process/outcome) and how to gather the data
2. Assess the outcomes from the young people’s viewpoint as well as the viewpoint of  those in charge of the program
3. Disseminate the results

Important issues to discuss:

• how to monitor the implementation (with the target audience or/and the professionals involved)
• Are the outcomes measurable and how? Do they fit with the intervention’s objectives?
• What has to be done if the outcomes are not reached?
• Identify target groups for the dissemination of the results.