Adolescent Age & Life-Stage ASSESSMENT AND COUNSELING TOOLS Guiding adolescents on the road to young adulthood Acknowledgments The Adolescent Age and Life-Stage Assessment and Counselling Tools were made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the Maternal and Child Survival Program and do not necessarily reflect the views of USAID or the United States Government. Individual Acknowledgments The Adolescent Age and Life-Stage Assessment and Counselling Tools were developed for the Maternal and Child Survival Program (MCSP). Adelaida DeGregorio, MCSP/Save the Children was the principal writer with major contri- bution by Aderonke Are-Shodeinde, MCSP/Save the Children and Brad Kerner, MCSP/Save the Children. Jana Spacek, MCSP/Save the Children also provided significant support to the development of the tools. Aderonke Are-Shodeinde led the multiple rounds of pre-testing of the tools. Save the Children colleagues, Melanie Yahner, Shannon Pryor, Deb Almond and Wendy Castro, provided valuable contributions throughout the process. We acknowledge our local stakeholders and partners in Nigeria who helped review, pre-test and field test the Toolkit: Ebonyi colleagues from the Adolescent & Youth-friendly Health Center (AYFHC) of the Federal Teaching Hospital (FET HA), Ebonyi State Ministry of Health, Ebonyi State Ministry of Youth & Sports, Local Government Service Commission of Abakaliki; MCH Onueke, MCH Azuiyiukwu, & Nwofe Health Centers, and Adolescent leaders & members from the local Youth NGO– GRADE Foundation from Abakaliki, Ebonyi state, Kogi colleagues from the Kogi State Ministry of Health, Kogi State Ministry of Youth & Sports, Kogi State Ministry of Education, Kogi State Specialist Hospital, Federal Medical Center, and the PHCs of New Layout, Old Market, Angwan Yashi & Angwa Kura; and Adolescent leaders & members from the local Youth NGO – “Light of Hope” from Lokoja, Kogi state. We also highly appreciate our MCSP state teams - Dr. Gladys Olisaeeke and her Ebonyi state team members, and Dr. Gabriel Alobo and his Kogi state team members, for their tremendous support and assistance in our field activities during the pre-testing and field testing of the toolkit. We wish to thank the following colleagues for their review and contributions in providing direction on the technical content of the tools: Cate Lane, Clifton Kenon, and Teshome Woldemedhin from USAID; Anne Pfitzer, Mychelle Farmer, and Neena Khadka from MCSP; Subidita Chatterjee (independent consultant); Oluyemisi Omobolanle Ayoola (Federal MO HNigeria), Fatima Muhammad (Society for Family Health-Nigeria), and Anne Kpason from Save the Children Nigeria. Additional technical contributions on the counselling cards were provided by the following colleagues from Save the Children, MCSP, and Jhpiego: Chris Hook, Shannon Pryor, Stella Abwao, Joya Benerjee, Neeta Bhatnagar, Silvia Kelbert, and Alice Christensen. Green Communication Design, Inc. led design and layout of this publication, while the counseling card illustrations were developed locally in Abuja, Nigeria by Corporate Graphics & Advertising Limited, Nigeria. The FP Effectiveness Chart illustration used for the Contraceptive Method counseling card was developed by JHU-CCP, WHO and US AID, and used with permission. Published December 2016 Introduction and Health Provider Instructions The Adolescent Age and Life-Stage Assessment and Counselling tools present a STEP #1: Determine which assessment tool to use by asking the adolescent – set of tools and counseling cards for use by health providers and health workers the 3 questions below: who treat and counsel adolescent clients on a one-on-one basis at the health 1. What is your age? facility. It primarily aims to support health provider efforts to seize teachable 2. What is your marital status? moments while talking with adolescents and look holistically at their lives while 3. Do you have children? Are you or could you be pregnant? being mindful of their sexual and reproductive health risks and protective factors. These tools help health providers understand the heterogeneity of ado- STEP #2: Explain to the adolescent their right to privacy and confidentiality. lescents and target their counseling based on the adolescent’s age and life-stage Confidentiality agreement in order to provide them with sound, practical and actionable advice. Before starting the assessment and counselling process with the Using the World Health Organization’s Adolescent Job Aid as a starting point, adolescent client, it is essential to establish rapport with your client. a total of 8 tools are included based on the specific ages, including very young Say: adolescents and older adolescents, and life-stages, including sexual activity, » Our discussion will be kept confidential and your per- marital status, and first time parents. For each age and life-stage, a full psycho- sonal information will not be discussed with anyone social counseling tool is presented based on the HEADS pneumonic (Home, else without your permission, except those involved Education/Employment, Eating, Activities, Drugs, Depression, Sexuality, Safety).   directly with your medical care. In addition to the 8 HEADS Assessment Tools, we have created a set of 23 » Confidentiality will only be broken if you have been supplemental Counseling Cards on specific topics that health providers can use harmed or if you are likely to harm yourself or others with adolescent clients for a more thorough consultation and counseling. While or if you are thinking about suicide. we understand that health providers do not have the luxury of time to counsel » Consent or confidentiality requirements may change all adolescents, our hope is that it will be possible to complete a full assessment once you are no longer a minor. and counselling session in 20 minutes with sufficient training. » If you are accompanied by an adult, relative, parent or Before using the tools, the health provider needs to ask the following questions partner, you will be asked if you prefer them to leave to help guide her/him in classifying the age and life stage of their adolescent for part of the discussion. That choice is yours. client, and decide which tool to use. » You can provide information, guidance and assist them to determine their own plans of action. ADOLESCENT AGE AND LIFE-STAGE ASSESSMENT AND COUNSELING TOOLS Chart of Assessment Tools TOOL #1 Unmarried Very Young Very Young Adolescent Girl Adolescent Girl TOOL #2 10-14 Years Old VYA Married Very Young Adolescent Girl Very Young Adolescent (VYA) Very Young TOOL #3 Adolescent Boy Very Young Adolescent Boy VYA TOOL #4 Unmarried Older Adolescent Girl TOOL #5 Older Unmarried and Pregnant or Parenting Adolescent Girl Older Adolescent Girl OA TOOL #6 15-19 Years Old Married Older Adolescent Older Adolescent Girl (OA) TOOL #7 Unmarried Older Older Adolescent Boy Adolescent Boy TOOL #8 Married and/or Parenting OA Older Adolescent Boy ADOLESCENT AGE AND LIFE-STAGE ASSESSMENT AND COUNSELING TOOLS List of Counseling Cards Puberty (Card #1) Body Changes for girls (Card #2) Body Changes for boys (Card #3) Menstrual health (Card #4) Caring for victims of gender-based violence (Card #5) Abstinence and delaying first sex (Card #6) Becoming Pregnant (Card #7) Dangers of Using tobacco, alcohol and drugs (Card #8) Emotional well-being (Card #9) Healthy eating (Card #10) Physical activity (Card #11) Contraceptive methods (Card #12) Dual Protection and safe sex (Card #13) Preventing STIs and HIV (Card #14) Harassment and sexual abuse (Card #15) Personal safety (Card #16) Healthy timing and spacing of pregnancy (Card #17) Preventing early and unwanted pregnancy (Card #18) Pregnancy checklist (Card #19) Importance of antenatal care (Card #20) Importance of postnatal care (Card #21) Importance of Infant and young child health care services (Card #22) Importance of breastfeeding (Card #23) ADOLESCENT AGE AND LIFE-STAGE ASSESSMENT AND COUNSELING TOOLS HEADS Assessment Tool and Card Counseling Selection Table WHO WILL TOOL SPECIFIC COUNSELING CARDS GENERAL COUNSELING CARDS BE COUNSELED Puberty (Card #1) Body changes for girls (Card #2) Menstrual health (Card #4) Caring for victims of GBV (Card #5) Dangers of using tobacco, alcohol and drugs (Card #8) 10-14 years old Abstinence and delaying first sex (Card #6) Emotional well-being (Card #9) Very Young #1 Becoming pregnant (Card #7) Healthy eating (Card #10) Adolescent Girl Contraceptive methods (Card #12) Physical activity (Card #11) Unmarried Dual protection and safe sex (Card #13) Personal safety (Card #16) Preventing STIs and HIV (Card #14) Harassment and sexual abuse (Card #15) Preventing early and unintended pregnancy (Card #18) Menstrual health (Card #4) Caring for victims of GBV (Card #5) Becoming pregnant (Card #7) Contraceptive methods (Card #12) Dangers of using tobacco, alcohol and drugs (Card #8) 10-14 years old Dual protection and safe sex (Card #13) Emotional well-being (Card #9) Very Young #2 Preventing STIs and HIV (Card #14) Healthy eating (Card #10) Adolescent Girl Harassment and sexual abuse (Card #15) Physical activity (Card #11) Married Healthy timing and spacing of pregnancy (Card #17) Personal safety (Card #16) Preventing early and unintended pregnancy (Card #18) Pregnancy checklist (Card #19) Importance of antenatal care (Card #20) Puberty (Card #1) Body changes for boys (Card #3) Caring for victims of GBV (Card #5) Dangers of using tobacco, alcohol and drugs (Card #8) 10-14 years old Abstinence and delaying first sex (Card #6) Emotional well-being (Card #9) Very Young #3 Becoming pregnant (Card #7) Healthy eating (Card #10) Adolescent Boy Contraceptive methods (Card #12) Physical activity (Card #11) Dual protection and safe sex (Card #13) Personal safety (Card #16) Preventing STIs and HIV (Card #14) Harassment and Sexual Abuse (Card #15) ADOLESCENT AGE AND LIFE-STAGE ASSESSMENT AND COUNSELING TOOLS WHO WILL TOOL SPECIFIC COUNSELING CARDS GENERAL COUNSELING CARDS BE COUNSELED Menstrual health (Card #4) Caring for victims of GBV (Card #5) Abstinence and delaying first sex (Card #6) Dangers of using tobacco, alcohol and drugs (Card #8) 15-19 years old Contraceptive methods (Card #12) Emotional well-being (Card #9) Older #4 Dual protection and safe sex (Card #13) Healthy eating (Card #10) Adolescent Girl Preventing STIs and HIV (Card #14) Physical activity (Card #11) Unmarried Harassment and sexual abuse (Card #15) Personal safety (Card #16) Pregnancy checklist (Card #19) Importance of antenatal care (Card #20) Menstrual health (Card #4) Caring for victims of GBV (Card #5) Contraceptive methods (Card #12) Dual protection and safe sex (Card #13) Preventing STIs and HIV (Card #14) Dangers of using tobacco, alcohol and drugs (Card #8) 15-19 years old Harassment and sexual abuse (Card #15) Emotional well-being (Card #9) Older #5 Healthy Timing and spacing of pregnancy (Card #17) Healthy eating (Card #10) Adolescent Girl Preventing early and unintended pregnancy (Card #18) Physical activity (Card #11) Unmarried Pregnancy checklist (Card #19) Personal safety (Card #16) Importance of antenatal care (Card #20) Importance of Postnatal care (Card #21) Importance of Infant and Young Child Health Care services (Card #22) Importance of Breastfeeding (Card #23) Menstrual health (Card #4) Caring for victims of GBV (Card #5) Becoming pregnant (Card #7) Contraceptive methods (Card #12) Dual protection and safe sex (Card #13) Dangers of using tobacco, alcohol and drugs (Card #8) 15-19 years old Preventing STIs and HIV (Card #14) Emotional well-being (Card #9) Older #6 Harassment and sexual abuse (Card #15) Healthy eating (Card #10) Adolescent Girl Healthy timing and spacing of pregnancy (Card #17) Physical activity (Card #11) Married Preventing early and unintended pregnancy (Card #18) Personal safety (Card #16) Pregnancy checklist (Card #19) Importance of antenatal care (Card #20) Importance of postnatal care (Card #21) Importance of infant and young child health care services (Card #22) Importance of breastfeeding (Card #23) ADOLESCENT AGE AND LIFE-STAGE ASSESSMENT AND COUNSELING TOOLS HEADS Assessment Tool and Card Counseling Selection Table (cont’d) WHO WILL TOOL SPECIFIC COUNSELING CARDS GENERAL COUNSELING CARDS BE COUNSELED Puberty (Card #1) Body changes for boys (Card #3) Caring for victims of GBV (Card #5) Dangers of using tobacco, alcohol and drugs (Card #8) 15-19 years old Abstinence and delaying first sex (Card #6) Emotional well-being (Card #9) Older #7 Becoming pregnant (Card #7) Healthy eating (Card #10) Adolescent Boy Contraceptive methods (Card #12) Physical activity (Card #11) Unmarried Dual protection and safe sex (Card #13) Personal safety (Card #16) Preventing STIs and HIV (Card #14) Harassment and sexual abuse (Card #15) Caring for victims of GBV (Card #5) Becoming pregnant (Card #7) Contraceptive methods (Card #12) Dual protection and safe sex (Card #13) Dangers of using tobacco, alcohol and drugs (Card #8) 15-19 years old Preventing STIs and HIV (Card #14) Emotional well-being (Card #9) Older #8 Harassment and sexual abuse (Card #15) Healthy eating (Card #10) Adolescent Boy Healthy timing and spacing of pregnancy (Card #17) Physical activity (Card #11) Married or Parenting Importance of antenatal care (Card #20) Personal safety (Card #16) Importance of postnatal care (Card #21) Importance of infant and young child health care services (Card #22) Importance of breastfeeding (Card #23) ADOLESCENT AGE AND LIFE-STAGE ASSESSMENT AND COUNSELING TOOLS T O O L TOOL #1 # 1 Very young adolescent (10-14 year old), unmarried girl Questions about: HOME � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �1 EDUCATION/EMPLOYMENT � � � � � � � � � � � � � � � � � � � � �3 EATING � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �5 ACTIVITIES � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �6 DRUGS � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �7 DEPRESSION/SUICIDE � � � � � � � � � � � � � � � � � � � � � � � � � � �9 SEXUALITY AND REPRODUCTIVE HEALTH � � � � �10 SAFETY � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � �14