In compliance with the Constitution, enacted on October 5, 1988, the Ministry of Health formalized the Adolescent Program and presents its programmatic bases through the Maternal-Child Coordination (Comin). Adolescence, the age group between 10 and 19 years, is the period of life characterized by intense growth and development, which manifests itself through anatomical, physiological, psychological and social transformations. Adolescents correspond to 21.84% of the country’s population, and their vulnerability to health problems, as well as to economic and social issues, determines more specific and comprehensive care. It is known that statistical records on morbidity in this age group are still flawed. However, based on published studies, it is noted that most adolescents seek health units with ill-defined complaints, most often encompassing a psychosocial problem. In recent years, it has been observed that the pattern of family structure has undergone significant changes. These changes have affected and modified traditional mechanisms of family solidarity, which are considered basic elements of individual protection and a primary barrier against external aggression and social exclusion. Brazilian adolescents are suffering the impact of the family, sociopolitical and economic breakdown that the country is experiencing, with abandonment, drug addiction, abuse in all its forms, prostitution and crime being clear forms of serious social illness. The vulnerability of this phase of human transformation and the risks to which this population group is exposed in today’s society make it imperative to implement programs with comprehensive, multidisciplinary and intersectoral approaches. These programs should be based on health promotion policies, identification of risk groups, early detection of health problems, appropriate treatment and rehabilitation of adolescent health. OBJECTIVE The implementation of a service for adolescents is due to the need to serve an age group of the population that is actually left out of health care. Nowadays, when a child turns 12 years old, he or she is discharged from the pediatric ward and receives care in the medical clinic in a manner that is indifferent and inadequate for that age group. In 2002, the Federal Council of Medicine, through Resolution No. 1634/2002, determined that adolescent medicine should be an area of ​​practice within pediatrics. The outpatient clinic should be specifically designed for adolescents and should not be decorated in childish ways or be marked by the indifference of a cold medical clinic outpatient clinic. It should be an informative space, with a bulletin board with interesting and current articles for adolescents about drugs, sex, education, work, family, sports, etc., and an active waiting room. The team should be made up of doctors, nurses, nursing assistants, psychologists, nutritionists and social workers. All should have training in some adolescent health program. One place where internships in this program can be provided is the Center for Studies on Adolescent Health at UERJ. FLOWCHART Adolescents are usually referred from the pediatric services, the medical clinic and specialty outpatient clinic, the emergency care service or arrive by spontaneous demand. Every patient who enters the service, even if it is through a specialty, should have at least one consultation with the adolescent doctor. All adolescents and their families, on the day of their consultation, will participate in the activities in the waiting room. PERSPECTIVE OF CARE Medical scheduling will allow two new patients to be scheduled per shift, seven morning and five afternoon sessions. The capacity to serve 320 patients per month in the medical area. Scheduling in the non-medical area will be the responsibility of each specialty, according to the activity to be developed. To care for adolescents, a group of professionals with different specialties is needed, who depend on each other to achieve the common goal of adolescent health. Interaction between the different specialties can be done through interconsultation, through a referral and counter-referral system. Or the consultation can be performed in the same medical office by two different specialties. Adolescent health care, by its very biopsychosocial nature, requires a work team of professionals from different disciplines. Regardless of the profession of origin, they must know the basic characteristics of this age group, be willing to listen and feel, to participate in the work, and be aware of their role within the context of the program and the commitment. As most hospitals have a range of specialties available, you can obtain an opinion on the same day, through an interconsultation or the referral and counter-referral system. Team integration for discussing clinical cases should be carried out daily, with all members present, at the end of each shift, so that each clinical case can be better managed. This interaction between team members, with joint discussion and shared decisions, will result in the prospect of a more complete and superior therapeutic plan than would result if each professional acted alone. The team should consist of at least two doctors specialized in adolescent medicine, a gynecologist, a psychologist, a social worker, a nurse and a nutritionist. All must have taken a training course. The outpatient clinic schedules can be organized as follows:

• medical clinic – four times a week, in two shifts per day;
• gynecology – two shifts per week;
• psychology – three times a week, one shift a day;
• nursing – once a week;
• social service – three times a week, one shift a day;
• nutrition – three times a week, one shift a day.

SERVICE STRUCTURE: MATERIAL RESOURCES AND PHYSICAL SPACE The adolescent service will have consultation rooms for individualized care for this age group and a large waiting room, where educational activities can be carried out. An office for clinical and/or gynecological care should contain:

• gynecological table (can be used for clinical examination);
• a screen;
• a Filizola scale for adults;
• a stadiometer;
• a pressure gauge;
• an orchidometer;
• a stethoscope;
• an otoscope;
• an ophthalmoscope;
• weight and height and growth rate charts;
• tables with Tanner stage;
• specific anamnesis forms for adolescent outpatient clinics, requests for examinations, requests for opinions, referral and counter-referral forms;
• own file;
• portable light focus;
• common office furniture (desk with two drawers and three chairs);
• negatoscope;
• sink, liquid soap and disposable paper towels;
• computer with specific program for adolescent medicine.

Another room, which can be used by psychology, social services, nutrition and nursing, must contain:

• table with two drawers and three chairs;
• three-seater sofa (which can be used as a divan);
• a Filizola scale for adults;
• a stadiometer;
• computer networked with the other room.

The waiting room, spacious, airy, bright, exclusively for the use of teenagers and their companions, must contain:

• mobile chairs for waiting for customers and for use in group meetings;
• 20-inch television, which must be in a privileged location, for everyone to see;
• videocassette;
• two corkboards to display current articles of interest to this age group, calls for meetings with groups of teenagers and/or families and information on sex, drugs, teenage pregnancy, sexually transmitted diseases, work, AIDS, etc.

The waiting room can be defined as a health promotion strategy that can be implemented in any outpatient or hospital setting, without the need for specialized technology. All that is needed is a group of people or clients who are waiting for care and a professional who is interested in coordinating this group. It is a field of practice and knowledge in the health sector that has been more directly concerned with creating links between the health team and the population. Health services present a unique opportunity to bring together and connect popular groups, and from this group, situations can be created that are exemplified by the experiences of this clientele and that can configure initiatives to search for solutions, using techniques built on the dialogue between popular knowledge and academic knowledge. The priorities and necessary educational knowledge continue to be determined by the group of technicians, without being questioned by the reasons, interests and knowledge of the population, but now they seek to cover them with local discourses or associate them with knowledge of the population itself. The main objective of this technique is to transform the individual’s behavior, focusing on their lifestyle and placing it within the family nucleus and, at most, in the environment in which they find themselves. The waiting room takes place daily at the beginning of each shift, with variable duration, and can last from 50 minutes to a maximum of 90 minutes in situations where the discussion mobilizes the group a lot. It is carried out by team members, usually in pairs, and can alternate between social workers, nurses, doctors, nutritionists and other specialists. The topics are selected by the clientele and vary according to the situations experienced by this population. Current issues usually arise, such as elections, violence, war, economy, etc., but more specific topics related to adolescence are highly requested, especially drug use, smoking and illicit drug use, oral health, health of working adolescents, sexuality, sexually transmitted diseases, AIDS, pregnancy, contraception, violence, accidents, family problems, school difficulties, adolescence in general, self-esteem, life project, citizenship, body development, etc. It is a technique that does not require advanced technology, and simple display materials such as posters, magazines, videotapes, slides , etc. can be used . The target audience is made up of adolescents who seek health services and their companions, but it is important to emphasize that, depending on the group’s objective, this audience can be separated and worked with specific themes for each one. IMPLEMENTATION SCHEDULE

• First stage – raising awareness among the hospital director and the head of pediatrics regarding the need to implement an adolescent service;
• second stage – raising awareness among the hospital director to release funds for purchasing materials and building the physical space;
• third stage – competition for doctor specializing in adolescent medicine, gynecologist, psychologist, social worker, nutritionist, nurse and nursing technician;
• fourth stage – awareness-raising course at the Center for Studies on Adolescent Medicine for hospital professionals;
• fifth stage – dissemination of information about the Adolescent Outpatient Clinic, opening hours and opening date;
• sixth stage – inauguration of the service.

GUIDELINES

• In two years, implement a tertiary care service, reserving a certain number of beds for adolescents;
• in the same period of time, expand outpatient care to primary care units of adjacent services;
• participate in the Soperj Adolescent Committee;
• hold lectures in communities on topics of interest to teenagers and with the participation of the entire multidisciplinary team;
• present scientific papers at conferences on adolescents.