1. Pre-service Education on FP and AYSRH
Session III Topic 8 Screening and History Taking for Adolescent SRH Service Provision

2. HEADS Assessment Home Education/Employment Eating Activity Drugs
Sexuality
Safety
Suicide/Depression
Explain that one way to apply a more rigorous screening to adolescent clients is by using a HEADS assessment (developed by WHO), which allows the provider to get a full picture of the adolescent as an individual as well as identifying behaviors, factors, and potential warning signs for abuse or coercion in the adolescent’s environment. HEADS. Show the slide on HEADS assessment.
Ask students to brainstorm what types of questions would be useful for each of the categories on the slide. For example, the category “Home” might include:
Where they live
With whom they live
Whether there have been recent changes in their home situation
How they perceive their home situation
Distribute Handout #1 HEADS Assessment and go through the items in each category.

3. SRH Assessment Menstrual History
Pain and excessive bleeding during periods
Knowledge about sexuality
Sexual activity
Pregnancy and contraception
Slides 5-7
Ask students to brainstorm basic topics that might be included in a SRH examination.
Ask students to brainstorm what might make an adolescent more comfortable during a physical examination.
Show slides to fill in any missing information
Provide students with Handout 2, SRH Assessment

4. Before the Physical Examination
Explain why the visit is important.
Respect the adolescent's sensitivity about privacy.
Inform the adolescent about what the nature, purpose, and content of the examination is.
Offer to have the exam performed by a provider of the same sex if possible or make sure there is a same sex attendant in the room during the exam. Obtain the adolescent’s consent to perform the examination.
A good rapport between the provider and client is essential. Try to establish trust.
Reassure the adolescent that the results of the examination will remain confidential.

5. During the Physical Examination
Protect her/his physical privacy as much as possible. Make sure curtains are drawn, doors are shut, and that no unauthorized person enters the room during the examination. Allow her/him to keep on her/his clothes except for what must be removed..
Provide reassurance throughout the exam. Explain what you are doing before you begin each step of the examination..
Provide constant feedback in a non-judgmental manner. "I see you have a small sore here, does it hurt?"
Watch for signs of discomfort or pain and be prepared to stop the examination if needed.
Delay pelvic and blood test, if the adolescent desires.

6. Female Physical Examination
General Physical Examination
Conduct a general physical examination of all systems.
Examine her for signs of anemia.
Breast examination
The breast examination should become part of the general medical evaluation once girls have breasts.
The main part of the examination is just looking at the breasts to check for abnormalities.
Examination for breast cancer is not necessary until at least age 18
The most common concerns girls have about their breasts is whether they are too big or too small, when they are going to grow or why one is bigger than the other. Reassure the client that there is no right or wrong and that her breasts are normal.
Divide students into 2 groups
Provide each group with a piece of flip chart paper and a marker.
Ask both groups to brainstorm what should be included in a physical examination for both sexes.
Have the groups record their answers on the flip chart paper.
Allow 15 minutes
Reconvene the larger group
Ask each group to present their conclusions. Ask both groups to explain why each examination should be conducted.
Show Slides 8-10 to fill in any missing information

7. Female Physical Examination (continued)
Vaginal Examination
The pelvic examination may be deferred in young adolescents who have regular menstrual cycles or who give the typical history of irregular cycles soon after menarche, and who have normal hematocrit, deny sexual activity, and will reliably return for a follow-up visit.
If a pelvic examination is necessary- in order to relieve anxiety
A virginal adolescent may fear that a speculum may tear the hymen. Explain that the hymen only partially covers the vagina and a speculum will not tear it.
Let her see and touch the speculum.
Examine the external genitalia for ulcers, warts, discharge, trauma and pubic lice.
Gently insert the speculum and examine the vagina for signs of infection or trauma.

8. Male Physical Examination
General Physical Examination
Conduct a general physical examination of all systems.
Genital Examination
Visually inspect the genital area, including the anus for ulcers, warts, urethral discharge, trauma or pubic lice.
If the young man is not circumcised, gently retract the foreskin to look for ulcers on the glans penis.
Palpate the testes for any abnormal enlargement
Teach testicular self examination for early signs of abnormalities that could be related to testicular cancers