A. Define and clarify the terminology relating to adolescents and risk

• risk
• youth at risk
• risk behaviour
• risk-taking behaviour
• exploratory and experimental behaviours
• perception of risk

Minilecture

Group work

Issues that may be included in lecture: the question of genetic versus environmental influences; the short and long term impacts on health; gender specific issues in exploratory behaviours.

Group tasks:

1. List at least 5 exploratory behaviours, for boys and girls separately, that are prevalent in the local contexts represented.
2. Estimate prevalence of these behaviours and compare with existing data from country or regional level. (Data provided by teacher)
3. Discuss the following questions: when does exploratory behaviour become risk-taking behaviour? What is sensation-seeking behaviour?
   Discuss the concept of clustering of risk-taking behaviours.

Behaviour examples: a 14 year-old girl is sexually active without protection against pregnancy and STD’s; a 16 year-old boy smokes 1 pack cig/day and uses cannabis on weekends.

Using the grid on bio-psychosocial development in appendix 1, identify characteristics of developmental stages that might drive the behaviour; try to find developmental processes where the behaviour might be instrumental to promote developmental tasks.
How might asynchronous pubertal maturation (earlier, later than peers, physical development preceding cognitive development) affect risk-behaviour?

Refs 2, 3

Appendix 1

Module A1

Discuss how the misperception of social norms and the erroneous estimations (over and under) of their peers’ behaviour affect an adolescent’s own risk behaviour.

Question: Could abstinence or fear-based prevention strategies be ineffective or even counterproductive by inducing “reactance”  (“forbidden fruit” phenomenon”)?

Discuss the drawbacks of using the concept of risk as a focal point in one’s clinical practice with adolescents

D. Define the concept of resilience, using Luthar’s definition as a starting point

“…  a process which refers to the presence of a threat to a person and evidence of positive adaptation of the adolescent despite adversity. “

Readings

Interactive lecture

Lecture presents key themes from the recent understanding of resilience, such as

• resilience as a multifaceted concept
• resilience as a dynamic interaction between risk and protective processes
• resilience as a process or resilience as an outcome
• universality of stress
• effect of the meaning one ascribes to stress

Reading, handouts or interactive lecture presents theories/definitions of protective factors.
Class discusses case study, as well as other examples from participants’ personal experiences. What factors contribute to making the example individuals resilient?

Case study:  A 23 year-old nurse remarks that she had a difficult childhood and many reasons that could have led to personal failure, including an alcoholic and schizophrenic mother, the early death of her father, and socio-economic problems. She fondly remembers her grandmother who often had to care for her, and who encouraged her to go into nursing.

To increase awareness of personal attitudes and to identify the values underlying these attitudes, participants work in small groups with the following questions:

Which adolescent behaviours bother you the most? Which behaviours do you hope your own children will avoid?  Do you know of any personal reason why you may react negatively to exploratory/risk behaviours? Which of your values are violated or enforced by the behaviours? How much is your opinion affected by the societal values around you?

Reading or minilecture

Group work

Participants review the philosophy of the HEADSSS approach (possibly before class).
In small groups, participants practice using a HEADSSS interview with a simulated patient or in role play.
Example of patient: a 15 year-old girl with multiple body piercings comes to a clinic with flu symptoms.

(Video taping of the role play would facilitate feedback sessions.)

Ref 12

Websites 1, 2

Module A3

Class discussion

Role play
Performance group

Discuss the following elements of preventive strategies that work with young people:

1. Emphasize short-term consequences.
2. Personalize the health problem.
3. Reach the adolescent in his/her “stage of change”.
4. Support adolescent’s own resources.
5. Use an autonomy- supporting style.
6. Align preventive messages with those from families, schools and communities

Role play, incorporating the above principles into a counselling session.
Sample patients: a 16 year-old boy who smokes has tried once to quit smoking. A 15 year-old girl who sporadically drinks too much is convinced that using condoms is enough to prevent pregnancy.

Class work

Role play

Using appendix 2 as a basis of the counselling approach, class work on the following case study:

Case: 16 year-old Richard is brought to consultation by his mother (a divorced professional) because she is concerned about his cannabis and alcohol use. She caught him smoking cannabis this morning before going to school. Richard was a good student until recently; he plays in a band with friends from school as well as a teacher. He claims not to care much about academic success because he is sure he will start a successful career as a music company owner. His mother voices great disappointment about this choice, saying that she wants her son to become a college teacher.