Youth Support Library

Plenary Session P6 Social and Behavioural Issues


Chaired by Joan-Carles Suris - Barcelona Spain and

David Baum - President Royal College of Paediatrics & Child Health London


The Care System   Keith Drinkwater

The Public Care System for children & young people in this country is in deep       Trouble!


This is a gross generalisation and I would not want to ignore the very good work done by the many skilled and committed staff in Social Services Department, nor the many success stories : families happily reunited, new families created and young people who have made a success of their lives.

Nevertheless, for years now we have been subjected to a barrage of news headlines which confirm the truth of my opening statement.   Inquiries & investigations into widespread abuse in children’s homes in Wales and prosecutions in Cheshire, Liverpool and elsewhere.   The report by the Social Services Inspectorate “Someone Else’s Child” which included 27 local authorities in England showed that there was not one where all safeguards were being applied.  Management was criticised and only 9 out of 27 authorities had plans for all of the children for whom they had responsibility.

A recent report by the British Agency for Fostering & Adoption showed that the problems are not limited to young people.  Even very young children often languish in care for several years before they are placed with adoptive families.

SOME FACTS - I in 200 children in this country is “in care” (used to describe both those who are  “Looked After” & where there is an order).  This is 0.5% of the population of under 18s in this country.  Children in Foster Care on average experience 5 moves. We are also becoming more aware of the incidence of abuse in foster care.

Young men in care make up 22% of the prison population.

38% of prisoners under 21 are, or have been, in the Public Care system.  

55% of homeless, single people were in care.  1/3 of rough sleepers were in care.

75% leave care without an education qualification, 25% of those aged 14 and over failed to attend school regularly, 80% had no job to go to.

Between 14-25% of young women leaving care have a child or are pregnant.   (Only 3% of 20 year olds in this country have children and the average age for a first child is 27).

Many of the young people in the care system have experienced difficult, disturbed and sometimes chaotic life styles.  Many will have experienced abuse or have experienced violence in the family.  Some will have developed a pattern of running away from home, truancy and delinquent behaviour.  This will often have resulted in a  “Mind Set”  which is characterised by concluding that there is no future – lack of planning – mercy of fate – impulsiveness -  with no concept of a  career  - or stable family life.   They are often not easy to help or even relate to.  The dice are stacked against the Public Care system succeeding in many respects, but these are all children, unique and of great value.

Many of the provisions for helping and supporting young people in the care system already exist. Representation & Complaints, Independent Visitors, Guardian ad Litem, training in how to relate to children etc.  Some solutions rest with Governments, both central & local. The Government has announced a number of measures recently, some directly relating to the care system, others such as provision for young children & the Social Exclusion Unit. Local Authorities are being urged & required to give higher priority to the care of the children and young people for whom it is responsible - eg to end the virtual abandonment of young people on reaching the age of 16 yrs (the power has existed for many years, refocusing away from largely ineffectual obsession with child protection. I hope that these measures are all successful.

There are some very simple things that we can do to improve the situation.  We can involve young people and really listen to what they have to say.  We can give them some real sense of control over what happens to them.  We can offer them opportunities to succeed in something – “Nothing succeeds like success”. Certainly nothing can give a boost to self-esteem, self worth, than being treated as if you are a person of value, listened to and taken seriously and given opportunities to succeed.

A young woman talking about being in care and the stigma attached to it stated:  “That can cause people to run away.  It really distresses them.  They make us feel like you’re an outsider.  You don’t belong.  You’re not human just because you’re not from a steady background”

Young people in care who were involved in Running Away responded to Who Cares Magazine and produced the following wish list:   Talk to the Kids & listen to them.

Have more experienced staff who’ve been in care or fostered and who know what they’re talking about.

Stop having incident meetings for the whole children’s home and just have a meeting with one member of staff and the young person.

Have more meetings for kids to talk about these issues with independent people, such as The Children’s Rights Service.

Treat young people as if they were their own children.

Not outrageous are they? Pretty modest really & very sensible/ reasonable. Are they too much to ask for our children & young people in our Public Care system?  I think not!


Epilepsy in Adolescence   Frank Besag


Although the incidence of epilepsy is high in adolescence and the prevalence of psychiatric disorder is  also higher than in childhood or adulthood, specific services for adolescents with epilepsy are rarely provided.  This subject also, surprisingly, receives little attention in many books on epilepsy. Adolescence is a time of great change, with growth into adulthood and the issues of preparation for university employment, driving, drinking, social/sexual   relationships  preparation for marriage /conception and a general increase of responsibility. Epilepsy impinges on all these areas to a significant if not major  degree.  In  addition,  adolescents  tend  to  be  very body-conscious and do not like to be different from their peer group.  The stigmatising effect of a condition which implies loss of control and requires the regular taking of medication is liable to have a very adverse effect on the adolescent unless the situation is managed well.  Denial of the epilepsy may lead to risk-taking which may include the refusal to take drugs or to take other precautions.

Management dilemmas

There are some specific management dilemmas in adolescents with epilepsy. Although the focus of both the initial interview and follow-up discussions should be on the adolescent, because the history depends so much on the informant it is necessary to interview the parents.  This situation needs to be explained to the adolescent.

Sodium valproate is the drug of choice for a number of the epilepsies of adolescence and is certainly the drug of choice for juvenile myoclonic epilepsy but may be associated with weight gain;  this is a particularly unfortunate adverse effect in body-conscious female patients, who may refuse to continue taking the drug.

The dilemma of declaring epilepsy on job/college applications may need to be discussed.  Although it is important to be honest with a prospective employer, the applicant will generally not obtain the job if they are not interviewed, and the declaration of epilepsy may prevent short-listing. One option used by some applicants is to leave the appropriate place on the form blank and, after the job has been offered, to declare the epilepsy in a positive way,  explaining how this  should not  interfere significantly with the ability to carry out the duties required and indicating what measures would need to be taken if a seizure occurred at work.

The broad area of independence versus safety is a difficult one for an individual who is trying to establish independence and a smooth transition to adulthood but may need to rely on others to some extent to maintain safety.  The specific issue of drowning in the bath must always be discussed in this context. The issue 'independence versus safety impinges on a number of other areas. Adolescents do not like being told what to do.  The doctor should try to avoid "giving advice" but should, instead, encourage questioning  and provide information,emphasizing that the individual is in control of his or her own life. The following are suggested rules for the doctor.

1. Always talk to the adolescent first, ignoring the parents initially.

2. Ask the adolescent to introduce the parents to you.

3.Explain to the  adolescent  what  will  happen  in  the appointment

4. View talking to the parents as a "necessary evil" and explain to the adolescent why this is necessary.

5. Write to the adolescent, not the parents.

6. Ask the adolescent's permission to send copies of the letters to the parents.

In addition the following practice points should apply.

1.         Check the diagnosis.

2.         Characterise the syndrome.

3.         Provide accurate prognostic information.

4.         Treat with appropriate medication.

5.         Provide information on the following.  The high risk of the unsupervised bath. The effect of irregular sleep  Alcohol  Driving Sport  Employment Contraception Genetic implications  Advantages/ adverse effects of specific antiepileptic drugs

6.         Listen, counsel, inform; avoid giving advice.


There are a number of syndromes which should not be missed.  The following may present in adolescence.

Juvenile myoclonic epilepsy

Juvenile absence epilepsy

Epilepsy with grand mal on awakening

Benign partial seizures in adolescence

Photosensitive epilepsy

Reading epilepsy

Subacute sclerosing panencephalitis

Epilepsy from cortical brain tumours

In particular,  the important syndrome of juvenile myoclonic epilepsy should not be missed.

Juvenile myoclonic epilepsy - This  is  an  idiopathic  generalised  epilepsy  syndrome  with age-related onset, commonly between 12 and 18 years.  The sex distribution is equal.  Bilateral, single or multiple irregular myoclonic jerks occur mainly in the upper limbs.  Most of the patients who present  for treatment  also have  tonic-clonic seizures  and  many  have  absence  seizures.  The  seizures predominantly occur soon after awakening. Patients often present with a history of one or more episodes of having a tonic-clonic seizure on awakening. The doctor should always ask specifically about morning myoclonic jerks, slowness or clumsiness.  Specific enquiry should also be made about "blank spells". Patients often do not declare the myoclonic jerks or absence seizures. If this information is not available a diagnosis of juvenile myoclonic epilepsy is likely to be missed. It is very important to diagnose this condition because most cases respond very well to sodium valproate but this needs to be continued long-term even  if  the  patient  is seizure-free for years the chance of relapse is high if the sodium valproate is stopped. It has been suggested that the new drug, lamotrigine, may be effective in subjects who do not respond adequately to sodium valproate.

Juvenile absence epilepsy -The onset of this syndrome is usually between 10 and 17 years. Males and females appear to be equally affected.  The subjects are usually neurologically normal.  A family history of epilepsy is common. The photosensitivity rate is high.  Over 80% also have generalised tonic-clonic seizures. Absence seizures usually respond very well to treatment with standard anti-absence medication such as sodium valproate or ethosuximide.

Epilepsy with grand mal on awakening -The peak onset is around puberty. The seizures occur exclusively or predominantly soon after awakening from sleep at any time of the day, with a second seizure peak during evening relaxation. Seizures may be precipitated by sleep deficit excessive alcohol or sudden arousal.

Benign partial seizures in adolescence - This syndrome needs to be distinguished from benign partial seizures of childhood.  The onset is 10 to 20 years with a peak around 13 to 14 years of age.  It is more common in boys.  There is usually no family history and no cognitive or neurological impairment.  The subject has simple or complex partial seizures, frequently with secondary generalisation. There may be a cluster of two to five seizures in 36 hours.  The patient may have only one episode of either a single seizure or a single cluster of seizures.   The EEG is typically normal or shows only mild abnormality.  There is no typical EEG pattern, in contrast to benign partial seizures in childhood with centro-temporal (rolandic) spikes. Because benign partial seizures in adolescence often present with only one seizure or cluster of seizures treatment should be avoided unless there is a recurrence or unless there are particular reasons for treating.

Photosensitive epilepsies -These are more common in adolescence. They are most often detected around 12 to 14 years, although careful history taking may elicit an earlier onset. Two-thirds of the subjects are female. Photosensitive epilepsies are not a single syndrome. It is always important to define the syndrome in which the photosensitive epilepsy is occurring, such as juvenile myoclonic epilepsy or juvenile  absence  epilepsy,  so  that  specific information on treatment and prognosis can be given.

Reading epilepsy - This is a rare, benign form of epilepsy with mean onset of 17-18 years.  It is more common in males.  There is a strong genetic predisposition. The diagnosis is facilitated by the very characteristic motor/sensory aura: after reading for a period, abnormal senations or movements occur in full consciousness, involving the tongue, throat, jaw, lips and face.  If the patient does not stop reading, this aura may progress to a tonic-clonic seizure.   If the subject stops reading when the aura occurs, tonic-clonic seizures can often be avoided and treatment with antiepileptic drugs may not be necessary.  If treatment is given then sodium valproate appears to be the drug of choice.  The interictal EEG is usually normal.

Subacute Sclerosing Panencephalitis - This typically follows measles infection very early in life, under two years usually presents in teenage years with relentless deterioration and eventual death. Initially there may be subtle loss of intellectual ability but myoclonic jerks or more complex abnormal movements soon become evident and the ensuing dementia is all too obvious. The EEG is characteristic, with a discharge in all leads when each jerk occurs. Measles antibody is raised in blood and is high in CSF.

Epilepsy from cortical brain tumours - Although  cortical  brain  tumours  can  occur  at  any  age, sub-tentorial tumours are more characteristic of childhood and are less likely to present with epilepsy.  In adolescence there is a greater risk of cortical tumours.  Because of this, serious consideration should be given to investigation with neuro-imaging of adolescents who present with partial seizures. The exception would be those with characteristic benign partial seizures, as described above, with a single seizure or single cluster of seizures and no recurrence of the adverse effects of the epilepsy,  even if the seizures themselves are controlled.

Conclusions -  Adolescence is an exciting but uncertain period.  Epilepsy may present for the first time in adolescence, adding greatly to complexities of this period. Well-established epilepsy may vary over the span of adolescence increasing the uncertainty when so many other changes are taking place.  In managing epilepsy in adolescence it is important to consider specific syndromes and causes because these may require very different styles of treatment or management. It is also important to consider impact of epilepsy on the life of the adolescent and to minimise the isolation and stigmatisation the teenager may feel at a time when being part of an approving peer group is so important. These factors plus issues of alcohol, driving, sport, contraception, genetic implications and "safety versus independence", imply that the management of epilepsy in adolescence requires skill and sensitivity.


Working with Young Men in Rural Communities  Simon Blake

I am currently project officer based at FPA London, responsible for a consultancy, training and project based service focusing on the sexual health needs of boys and young men.  From 1996 - 1998 I worked in South Wales running a Healthy sexuality in the Community project - targeting boys and young men.  The project is still continuing today, and based on its success and a recognised need is now working with younger boys aged 11 - 14.  The work that I am going to outline today was with 14 - 20 year old young men.  The project tutor team consisted of myself and 10 volunteers who were recruited from the local communities and underwent an extensive training programme. 

What I hope to do today is

·      outline a rationale for using the volunteer model

·      outline the reasons for specifically targeting young men

·      share the projects experience and the underlying principles which it has found effective when working with young men

·      provide some practical strategies when working with young men.

In doing this I will draw upon the findings of the Sex Education Forum’s project ‘Let’s Hear it for the Boys’ of which I was a member of the working group.   Before starting I would like to remind you that young men are all shapes and sizes, come from different races, religious and cultural backgrounds, have different abilities and disabilities and different sexualities.  Today I will aim to highlight general principles of good practice when working with young men.

So what is currently happening with young men in the UK?

They constitute approximately 3-20% of all Sexual Health service users - and generally do not ask for help at all.  The repercussions of this are highlighted by the increasing suicide rates, and the rise in STI’s, where HIV infection still remains particularly high amongst young gay and bisexual men.

Girls and young women are overtaking them academically at both G.C.S.E.  and A level standards and there are high levels of concern at the social exclusion levels amongst young men.  Homophobia is still rife - the recent report by THT Playing It Safe re-emphasised the traumatic experiences many gay men have at school.  Prejudice comes from both teachers and peers.

And specifically in sex and relationships education:

Many workers in the field report that they are disinterested, they do not listen and they do little but mess around. The Sex Education Forum’s project and the FPA project in Wales show that young men are interested, they do want to talk - but  about issues that interest them.  Young men say that their sex education is ‘too little, too late, too biological’.  The most common feedback I get from young men when talking about the sex education sessions is -’it was good because you asked us what we want.’

The sessions also need to be delivered by somebody that the young men relate to.  This is where the benefits of the volunteer model training people from the communities apply.  Before becoming a sex educator they undergo the FPA’s accredited training programme, and then with ongoing training, support and supervision from myself and peers provide educational opportunities in their communities.

If I can tell you a little bit about Rhondda Cynon Taf and Merthyr Tydfil.  They are old mining communities where since the breakdown of the mining industries massive poverty and unemployment has arisen.  Some members of the community are resistant to outside ‘professionals’ preaching about lifestyle change.  I was one of those professionals -

‘I confidently walked into the centre for the first of a series of sessions.  I felt good having just returned from a beautiful holiday - the reception I received was far from empowering, I was hurled racist and homophobic abuse.  Racist because I have dark skin and had a sun tan, and homophobic because I dared to try and work with young men around issues of sex and sexuality - I must be gay and a child abuser.  I left to find my car trashed - the wing mirror broken and felt silently shattered as I drove the A470 home.

3 months later a male and female volunteer from their community, with the right accent and the right experience delivered a set of 6 very successful and wonderfully evaluated sessions.  This really emphasises the point that young men must have somebody they can relate to, who they do not find threatening.

This is a crucial learning point when working with any group - since then I am delighted to say I have had no more experiences of this kind - and the sessions run by myself and the volunteers have been very well received.  The key learning points from working with the young men over a period of two years have been.

Have a positive starting point - we must move away from the idea that young men are a problem that need to be changed.  As a colleague described ‘it is about trusting that young men are ok and the more chance they get to explore their sexuality the less likely it is that they will abuse themselves and others’. 

Use opportunistic interventions - it will not always be possible to do groupwork immediately.  You may need to use television programmes and situations within the setting to just offer a line or two or engage in conversation with young men.

Consult with the boys - do not assume that you know what young men want and need.  Consult with them, ask them what they want, where they want it and who with.  Sex and relationships education sessions are not likely to be able to compete with certain activities.  This also creates an ethos where the young men feel involved in the process and are more likely to participate.

Create a safe environment - talking about sex and relationships amongst young men is often a new experience.  They need to feel safe in doing this.  It will be easier to do if there is a clear policy and values framework within the whole setting that supports the specific education sessions.  Below are some strategies for doing this.

You as the best resource -  Young men need the opportunity to engage in a genuine dialogue.  To enable them to do this they need to feel confident in the facilitator.  Young men have said that it is important not to feel embarrassed, or in particular to be embarrassed by the facilitator.  By showing empathy with the young men’s experience and really listening to them you can optimise the time that is spent with the young men.

Use a developmental programme - there is general agreement that active learning methods that involve the young men In their learning work best in sex and relationship education.  Involving the young men will also ensure that the sessions are relevant to them.  Ask them what they would like to cover. Use trustbuilding  games and activities to increase the safety of sessions.  Explore the ‘safer’ topics first, ones which are information based, and as young men become more confident in working in the group move onto exercises that explore attitudes, values and emotions.

Third person techniques - Using role play, drama, case studies that are relevant to young men so they can explore situations without being exposed to peers and vulnerable to bullying.

Single sex groups - these allow the young men to explore issues and concerns that are relevant to them.  Girls and boys have different concerns and worries, in single sex groups boys can explore what is relevant to them without being censored and importantly without ‘losing face’ in front of the girls.  It also encourages them to support each other and experience a different way of being together.  However some young men have specifically asked to work in mixed sex groups and it is important to respect their wishes.

Male of female tutors - there are often debates about whether male or female facilitators are best.  Young men have said it is not that important although they would like a man for some issues.  More important than gender however is empathy with their experience.  The project in Wales has male and female volunteers and both have been equally successful. We must acknowledge the importance of involving men as educators and encourage and support them in taking on this role. They can provide positive role models, and of course they know what it is like to grow up as a boy and a man.

To conclude, it is important to develop and review policies, explicitly stating how the needs of boys and young men can be met.  Consult with them, listen and review

Working with young men is challenging and rewarding, ultimately doing the work has enabled me to learn to like young men more, and understand that the pressures heaped upon them (and myself) to behave in certain ways can make growing up a very painful and isolating experience. 

The work has been written up and and published by the FPA in 1998.  STRIDES: a practical guide to sex and relationships education with young men. Simon Blake and Joanna Laxton.  It contains theoretical background, guidance on planning, delivering and evaluating sex and relationship work with young men and practical exercises and ideas.  At £15.99 it is an absolute bargain and has been endorsed by the National Youth Agency, with Gill Lenderyou, senior development officer at the Sex education Forum stating, ‘at long last a resource that will really help improve and develop sex and relationships education for boys.



Health Education For Adolescents - Does it Modify Behaviour?  Christine Ferron

I would like to start my presentation by clarifying a point that seems important to me, in order to eliminate the risk of misunderstanding. When I sent my abstract to Youth Support, a few months ago, its title was : "Health education for adolescents : how can we make a difference?" This title was changed to : "Health education for adolescents : does it modify behaviour?". Different cultural sensitivity? Different perception of health? Different perception of education? My first reaction was to ask for a return to my first proposition, then I thought that it might be an interesting point to make in my introduction.

To modify behaviour : is that really, and always, what we want? If yes, is there always a defined direction? Does it mean that we can always relate to consensual norms? Are there recipes to accommodate adolescents' behaviour to our taste? When we have done our educational duty, how can we know whether we actually modified behaviour in our public? How can we be sure that behaviour was changed in the way we wanted? How do we measure behaviour? By asking? "Hey you, did you use condom at last intercourse?" 75% of French adolescents would answer "yes" to this question… And if there is still a probability that we failed in our attempt to change adolescents' behaviour, should we then stop doing health education with adolescents?

Maybe you see where I am getting to. My initial interrogation "How can we make a difference?", was more modest, more realistic, and more methods-oriented than results-oriented. In France, to modify behaviour is certainly not an objective for national prevention programs which are implemented through a large media coverage. Rather, these programs intend to give young people opportunities to think about their health, to clarify their choices, and to make them aware of their responsibilities. Although the possibilities of changing behaviour may be more important in local actions, this objective is not central to prevention programs which are implemented in schools, neighbourhoods or communities either. In this context, to do health education means to increase young people's awareness of their ability to be in charge of their own health and to adopt a healthy behaviour. Depending on the adolescents' personal situation and social context, behavioural change may or may not occur. It may also take more than one action before a slight change in attitude, a slightly raised consciousness, initiates a process towards a healthier life style. How can we contribute to this evolution , how can we make this difference?

There is a fundamental misunderstanding between young people and health professionals. For the latter, an excessive use of tobacco or alcohol, using drugs, taking risks, getting pregnant, are all problems. For the former, these are answers to their problems. So there must be a misunderstanding on solutions also : trying to modify behaviour on one side, finding a place and a role, a life project, a reason to live, on the other side. Health professionals' attitude often consists in unplugging alarm systems, without knowing why they started to ring in the first place. For health professionals, there are three main traps that should be avoided : rationalisation, an overly medical approach and blaming the victim.

Adults' behaviour is not rational : in French, we say that "le cœur a ses raisons que la raison ne connaît pas", which means that you may fall in love with someone who is apparently not the right person for you. In adolescence, determinants of behaviour are usually not more rational than adults', but maybe more specific : search for immediate pleasure, experimentation to test one's limits or to feel more intensively alive, peer pressure, need for recognition and belonging, perception of body and self… See, for example, the reasons for not using a condom with a new partner : rational assessment of risk has usually little to do with these reasons.

An overly medical approach of daily life is another risk. When medical knowledge takes all the available space, popular knowledge is impeached and the transmission of skills within the population is disqualified. For instance, when we talk about nutrition with adolescents - a seemingly neutral subject - we must be very careful not to abate the worth of families' or parents' life style or food habits. Health professionals should be very well aware that their perception of adolescence and health behaviour depends on their own social, cultural and professional background. When we do health education with adolescents, we should acknowledge these personal values in order to leave them aside, for example when we talk about sexual issues with adolescents. There is our opinion, for example about sex out of wedlock, and there is the adolescents' sexual experience, and the latter should be central to our action.

Blaming the victim is the last trap, and we are very close to it when we focus our intervention on individual behaviour and individual responsibility, without taking into account other influential factors, like environmental ones. Then the risk is to increase a feeling of guilt, and adolescents really do not need that : because of the confused feelings associated with the sexualisation of their body, or with masturbation, guilt and shame are already part of the adolescents' psychological life. Increasing guilt, shame or fear inhibits their ability to take a positive action for themselves. So, what can we do in order to increase our chances of making a difference?

Let's start by relaxing a little bit. Stereotyped health education messages to adolescents usually sound like : "So you like that stuff ? Eating fast food, being drunk, driving fast, listening to loud music, even falling madly in love… Well, it's bad for you". Adolescents are then supposed to give up pleasurable experiences without even trying. Would a child learn how to walk without taking the risk of falling ? Adolescence carries deviance by its very essence. One of adolescents' tasks is to question the norms of their family or of society. Health educators should learn to give up any attempt to control or master adolescents' lives. We should really make a conscious effort to distinguish between risk and experimental behaviour. Risk behaviour is adopted by hopeless adolescents, who place their life at stake. These situations represent social emergencies. Experimental behaviour helps adolescents build their identity and helps them know who they are. Adolescents' normal experimentations will be naturally structured by their self esteem and their psychosocial skills.

How can we try to help adolescents develop their self-esteem and personal skills?  First, let's try to talk about health in an educational framework, rather than in an instructional one. In the instructional frame, there is a corpus of knowledge which exists externally to the individuals and to the relationships between people. Relationships are central to the educational process, and knowledge is built inside the relation between health educators and their public, men, women, adolescents considered in all their dimensions (social, psychological, cultural, medical) and their objective living conditions. Health is not an ordinary subject, health issues are intimate and complex, and health information is never neutral, because it relies on particular perceptions and values. Our responsibility is to help adolescents build their own opinion from their contradictory desires and the contradictory messages they receive, help them find out the determinants of their behaviour, and develop their ability to listen to each other, to express themselves and to deal with their emotions.

Second, health education should be included in adolescents' projects and concerns, because information which is contrary to their beliefs and practices will not be heard. An action focused on a given issue should always start with an exploration of adolescents' knowledge, beliefs, opinions and worries about this issue. Mentioning a virtual risk of getting a disease in a distant future is not efficient in health education with teenagers : their representation of death is different from ours, some of them are more afraid of living than of dying.

Health educators will find support for their action within the reality of adolescents' lives and in their centres of interest : according to a study we conducted on the perceptions of health among adolescents, these centres of interest are :

·      relationships to others (misunderstandings, anxiety, self image, depression) and relationships to the surrounding world (television, politics, money, racism, poverty) ; 

·      interest for body functions (puberty, body image changes, sexual issues) and for the functioning of the universe (information, discovery, progress) ;

·      taking care (diseases, allergies, medications, pain) and having fun (temptations, appearance, attraction, fashion, friends) ;

and the main youth issues : on a negative side, internal violence (self-damaging behaviour) and external violence (conflicts, divorce, pollution), and on a positive side, the adolescents' capacity to take some distance (music, humour, and sleep).

A broad vision of health is the key to health intervention with adolescents. Instead of being invited to repeat adults' messages about health, they should be encouraged to express themselves and to say what they already know, what they wish they would know, what bothers them, what makes them unhappy, and to imagine their own solutions. This may occur during debates, role playing and group discussions. The French Committee for Health Education is very much involved in the training of teachers and school health professionals, because they remain in schools long after health educators - "outsiders" - have left. We believe that it is important for adolescents to have a permanent guidance for their health concerns, in the school they attend.

From the meeting of adolescents' skills and professionals' skills, new skills will emerge, which will increase the autonomy of all the partners of health education. The idea may be more to increase adolescents' ability to intervene, than their ability to get adjusted. Then health education will have a slightly higher chance of making the world a better place…

Christine Ferron, is a PhD working as Co-ordinator, Research and Training Programmes for School Health Education Programmes at Comité français d'éducation pour la santé (French Committee for Health Education).