1. Pre-service Education on FP and AYSRH
Session III Topic 5 Communication with Adolescents

2. Tips for Good Communication with Adolescents
The following are tips for good communication:
• Be genuinely open to an adolescent’s question or need for information (ranging from “Where is the toilet?” to “Should I use birth control?”).
• Do not use judgmental words or body language that suggest disapproval of adolescents being at the clinic, of their behavior, or of their questions or needs.
• Understand that the young person has various feelings of discomfort and uncertainty. Be reassuring in responding to the adolescent, making him or her feel more comfortable and confident.
• If sensitive issues are being discussed, help ensure that conversations are not overheard.
Ask for 4 volunteers to conduct 2 short roleplays.
Roleplay 1: An adolescent client and an insensitive receptionist. The adolescent attempts to make sure s/he is in the right place, asks what to do, inquires about procedures, etc. (and is very anxious and uncomfortable). The receptionist is busy, over-worked, believes adolescents should not seek RH care, and is indifferent to the adolescent’s needs and sensitivities.
Roleplay 2: An adolescent client and a trained, sensitive receptionist. The actors perform the same scenario as above, but the receptionist is understanding and wants to help make the overall clinical interaction a positive and effective experience.
Explain that the next exercise is to learn to use the clarification technique in order to help the adolescent client explore ideas and feelings, and to help clarify confusing or vague messages.
Distribute the Handout #1: Statements to Practice Clarification Technique.
For the first round, ask for 6 volunteers. Three should play adolescents and 3 should be counselors, with pairs seated facing each other.
The first “adolescent” speaks line #1 to her/his “counselor.” The counselor responds, attempting to clarify what the adolescent means with specific reference to the boldface words.
The 2nd and 3rd pairs repeat this process with lines #2 and #3.
Ask students to discuss the “counselor's” use of the clarification technique, making comments and suggestions.
Two more groups of 3 pairs complete the exercise, with discussions after each group.

3. What an Adolescent May Feel When Talking with a Provider
Shyness about being in a clinic (especially for SRH) and about needing to discuss personal matters.
Embarrassment to be seeking SRH care.
Worry/Concern that someone they know might see them and tell their parents, family, or caretakers, or spread rumors about them at school or in the community.
Inadequacy or unprepared to describe what is concerning them and ill-informed about SRH matters in general.
Anxiety that they have a serious condition that has significant consequences (e.g. STI, unintended pregnancy).
Intimidation by the medical facility and/or the many “authority figures” in the facility.
Defensiveness about being the subject of the discussion or because they ware referred against their will.
Resistance to receiving help because of discomfort or fear, or lack of trust in the health provider.
o Fear of being mistreated, judged, or turned away by clinic staff.
Ask students to brainstorm what emotions an adolescent may feel when talking with a provider and explain why an adolescent might feel the emotion.
Write their responses on a flip chart
Compare their responses with slide #3
Ask the students if any of them ever felt any of these emotions. Ask a volunteer to share an example of a time when one of these negative emotions kept them from seeking information or services that they needed at the time.

4. Roles
Providers and facility staff should remember ROLES when communicating with adolescent clients:
R = Relax the client by using facial expressions showing interest
O = Open up the client by using a warm and caring tone of voice
L = Lean towards the client, not far away from him/her
E = Establish and maintain eye contact with the client
S = Smile

5. Techniques to Help Assure Good Communication with Adolescents
Create a good, friendly first impression
Establish rapport during the first session
Eliminate barriers to good communication
Use “active listening” with the client
Provide information simply
Ask appropriate and effective questions
Recognize and take advantage of teachable moments
Briefly discuss the slides 4 and 5.
Divide the students into small groups for simultaneous role plays. Keep the number of groups to a size where the instructor(s) can observe role plays easily by moving around the room. For example, if there is one trainer, divide students into fewer, larger groups. If there are multiple trainers.
Ask the students to perform role plays, using role plays in Handout #2 Communication Role Plays. Students will perform in pairs, with other member observing and providing feedback. ‘Providers’ should roleplay all aspects of screening and counseling. If a particular exam or procedure would normally be done (e.g., when providing a contraceptive method), students should announce to the observers what they would do if they were in the clinic (i.e. now I would take the BP).
Distribute Handout# 3 on Techniques to Help Assure Good Communication with Adolescents. Explain that this handout should be used as a checklist when observing the roleplays.
Each student should participate in at least three role plays and play the provider and the client, as well as the observer at least once each.
Allow actors/players about 10 minutes to prepare, limit each role play to 5 minutes, and allow about 15 minutes for feedback and analysis of the process and content.
Instructors should rotate groups after the first one or two role plays in order to get as many trainer observations of individual students’ counseling skills as possible.
See next slide note to continue

6. Fostering Good Communication
Several principles help assure effective counseling with adolescents:
Analyze and reflect on the issues troubling the young person
Encourage him/her to explore and express feelings
Avoid giving advice and magic formulas for solving problems.
Help the adolescent to evaluate her/his own behavior and the possible solutions to the problem.
Encourage the young person to take responsibility for her/his decisions
Consider adolescents as individuals, emphasizing their qualities and potential
Accept do not judge them as good or bad. consider necessary
Promote ownership of decisions, greater self-confidence, and self-control
Observe and assess each student for counseling content, process, and participation in the exercise.
Encourage and guide the students in constructive critique, in analyzing what was good about the way the counselor handled the counseling and suggesting what could be improved. Remind students not to confuse the actual student with the actor's role, and that feedback and critique must not be personalized.
The trainer's role during feedback/ discussion should be to stimulate, guide, keep up discussion, and end it when time is up. The trainer may wish to provide general feedback at the end of student discussion.
Take the final 15 minutes to summarize the major points observed in the exercise and respond to student questions with the entire group. Conclude by asking students to share the main points they have learned about adolescents and meeting their SRH needs

7. Communicating about Sexuality
Good communication and counseling about sexuality requires: • Considering the adolescent’s age and sexual experience. • Demonstrating patience and understanding of the difficulty adolescents have in talking about sex. • Assuring privacy and confidentiality. • Respecting the adolescent and their feelings, choices, and decisions. • Ensuring a comfort level for the adolescent to ask questions and communicate concerns and needs.
Slide 6 and 7
Explain that when the adolescent makes their own decision, with appropriate information, they will feel sense of satisfaction and will feel capable of voluntarily modifying their behavior.
Explain that communicating and counseling with an adolescent about sexuality can be challenging because it is a sensitive topic.
Ask students to raise their hands if they’ve ever felt, emotional, defensive or insecure when discussing sexuality and sexual and reproductive health with an older family member, teacher or health care provider.
Ask students to brainstorm some ideas or tips that might help when discussing sexuality with an adolescent.
Supplement their answers with the slide

8. Communicating about Sexuality (continued)
Responding to expressed needs for information in understandable and honest ways.
Exploring feelings as well as facts.
Encouraging the adolescent to identify possible alternatives.
Leading an analytical discussion of consequences, advantages and disadvantages of options.
Assisting the client to make an informed decision.
Helping the adolescent plan how to implement their choice.

9. Privacy
This characteristic relates primarily to the facility and requires a separate space where counseling and/or examination can take place without being seen or overheard and where the interaction is free from interruptions.
Slides 8-10
Explain that the more an adolescent client can be made comfortable, the more likely he or she will open up about his or her concerns, play a role in determining treatment and follow-up, and comply with medical decisions. The 3 most important characteristics of comfort for the adolescent client are privacy, confidentiality and respect.
Show the 3 slides on Privacy, Confidentiality and Respect.
Explain that this next exercise will address the importance of confidentiality, circumstances when confidentiality can or should be broken, and the legal climate within the country. Divide the students into 3 groups. Assign each group a number, 1, 2, or 3.
Distribute Participant Handout 4: Confidentiality Discussions. Ask each group to work on the discussion p with the same number as their group Allow 20 minutes for groups to complete their assigned task.
Ask each group to report back its conclusions to the plenary. Lead a discussion with the whole group following each report-back, by asking the other two groups for any additional responses, ideas, or experiences. Allow 10 minutes for each topic.

10. Confidentiality
This characteristic relates to the provider and requires that s/he assure the client that all discussions and matters pertaining to the visit will not be transmitted to others. If, in some circumstances, the counselor/provider believes it necessary to share information with others (for example, to prevent further sexual abuse), the counselor/provider should explain why it is important and explain to when, how, and with whom the information will be shared.

11. Respect
This characteristic involves the way that the counselor/provider relates to the adolescent, requiring recognition of the client’s humanity, dignity, and right to be treated as capable of making good decisions. Respect also assumes that one can be different and have varying/alternate needs that are legitimate and deserve a professional response.