World Health Organization · 1st edition, 2025
Competency-based education framework for health workers to deliver quality, adolescent-centred care across all practice domains.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- Ministry of health and education officials, curriculum coordinators, educators in teaching institutions, licensing authorities, professional associations, medical students
- Evidence
- Evidence reviews of peer-reviewed literature (2015–2024), national policy documents, global surveys of adolescents and adolescent health experts, expert consensus via Technical Working Group
- Reviewed
- 14 Oct 2026 · GMJ
What this guideline says
GMJ summary
This framework provides a comprehensive blueprint for developing pre-service and in-service competency-based education programmes in adolescent health and development. It extends WHO’s Global Competency and Outcomes Framework for Universal Health Coverage to address the specific health needs of the world’s 1.3 billion adolescents (aged 10–19 years).
The document identifies essential competencies, behaviours, knowledge, and skills that enable health service providers to deliver quality, adolescent-centred care that is respectful, confidential, and responsive to adolescents’ evolving capacities. It is structured in four parts: (1) 24 competencies across six domains (people-centredness, decision-making, communication, collaboration, evidence-informed practice, and personal conduct); (2) 35 practice activities across individual health, population health, and management domains; (3) 11 topic guides covering specific health areas (growth and development, mental health, substance use, sexual and reproductive health, nutrition, chronic conditions, injuries and violence) and cross-cutting topics (ethical practice, transition to adult care, telehealth, anticipatory guidance); and (4) implementation guidance for curriculum development.
The framework emphasizes adolescent participation, shared decision-making, confidentiality within appropriate limits, assessment of evolving capacity for autonomous decision-making, and integration of anticipatory guidance into all clinical encounters. It supports implementation of the Global Standards for Quality Health Care Services for Adolescents (2025).
Key points
For clinicians — doses and thresholds as stated in the guideline
- Health workers should conduct comprehensive psychosocial assessment (e.g., HEADSSS: home, education, eating/exercise, activities, drugs, suicidality, sex, safety) for all adolescents regardless of presenting complaint
- Confidential health care must be provided to adolescents with clear explanation of limits of confidentiality, spending time alone with the adolescent in each consultation
- Adolescent capacity for autonomous decision-making should be assessed individually using an approach that considers evolving capacity, not fixed age thresholds
- Shared decision-making should involve the adolescent, with family/caregivers engaged as appropriate and in consultation with the adolescent
- Anticipatory guidance on nutrition, physical activity, sleep, substance use, sexual health, mental health, and injury prevention should be integrated into all consultations
- Health workers should screen for mental health conditions (anxiety, depression, self-harm, eating disorders), substance use, and violence/abuse using validated tools
- Transition from paediatric to adult care should include transition readiness assessment, preparation of health summaries, and support for self-management skills
- Health workers must advocate for adolescents' rights to appropriate health information and care, addressing barriers for marginalized groups (LGBTQIA+, migrants, adolescents with disabilities, those experiencing homelessness or in justice systems)
Health worker competencies for adolescent-centred care across six domains
Table extracted from the guideline
| Domain | Key competencies | Adolescent-specific behaviours |
|---|---|---|
| I. People-centredness | Places people at centre; promotes agency; provides culturally sensitive care; incorporates holistic approach | Adapts to developmental level; empowers health literacy; respects autonomy; balances autonomy with capacity; involves trusted adults appropriately; provides care to marginalized populations |
| II. Decision-making | Takes adaptive, collaborative approach; incorporates systems approach; solutions-oriented; adapts to change | Engages in shared decision-making with adolescent and family; organizes practice flexibly to meet adolescents' needs; respects adolescent autonomy |
| III. Communication | Manages interactions; adapts communication; listens actively; conveys information; manages documentation | Manages privacy/confidentiality; spends time alone with adolescent; adapts to developmental level; shares information with consent; facilitates transfer documentation |
| IV. Collaboration | Engages in collaborative practice; builds partnerships; learns from others; manages conflicts | Works with multi-disciplinary teams including schools; mediates adolescent-family tensions; engages adolescent as active team member |
| V. Evidence-informed practice | Applies evidence principles; assesses data; contributes to quality improvement | Maintains awareness of adolescent-specific guidelines; manages care despite lack of adolescent data; collects age/sex-disaggregated data; supports evidence-informed self-care |
| VI. Personal conduct | Works within competence limits; demonstrates ethical conduct; engages in lifelong learning; manages own well-being | Applies individualized capacity assessment; upholds confidentiality, consent, dignity; reflects on own attitudes/prejudices regarding adolescent behaviours |
Source: World Health Organization, Competency and outcomes framework for adolescent health and well-being. Reproduced in summary form.
What changed in this edition
Versus the previous edition
- Structure updated to align with 2022 Global Competency and Outcomes Framework for Universal Health Coverage
- Content updated following surveys of adolescents, surveys of adolescent health experts, and evidence reviews
- Added emerging clinical priorities including telehealth, digital health technologies, and technology-facilitated violence
- Increased emphasis on adolescent participation in health service development
- Added cross-cutting topic guide on telehealth (Topic guide 10)
- Strengthened content on marginalized adolescent populations and equity
- Updated to support implementation of Global Standards for Quality Health Care Services for Adolescents (2025)
From the guideline
Verbatim
“It identifies essential competencies, behaviours, knowledge, and skills that enable health service providers to deliver quality, adolescent-centred care that is respectful, confidential, and responsive to adolescents' evolving capacities.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked with WHO on health systems strengthening in our region, I recognize that this framework addresses a critical gap in Georgia's primary health care capacity. While our UHC programme has improved access, our primary care physicians and feldshers often lack specific training in adolescent developmental assessment, confidential consultation skills, and comprehensive psychosocial screening—competencies that distinguish adolescent care from paediatric or adult medicine. The framework's emphasis on integrating anticipatory guidance into every encounter, not just 'well visits,' is particularly important for our context where many adolescents access care only episodically. I would stress to Georgian colleagues the competency on individualized assessment of decision-making capacity rather than rigid age thresholds, as our laws and clinical practices sometimes create barriers to adolescents accessing confidential sexual and reproductive health services or mental health care. The realistic implementation challenge will be the time required for comprehensive HEADSSS assessment and counselling within our current primary care appointment structures—this will require not just training but also health financing and workflow redesign to make adolescent-centred care feasible in daily practice, not merely an aspirational standard.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 14 Oct 2026
Applicability
Georgia and the South Caucasus
This framework is directly applicable to Georgia and the South Caucasus region, where adolescent health services are expanding within universal health coverage programmes. Georgia’s UHC programme (since 2013) and primary health care reforms provide an infrastructure for implementing adolescent-centred competencies. National programmes should consider: integration with existing maternal-child health platforms; adaptation of competencies for rural and mountain settings where adolescents may have limited access to specialized services; culturally appropriate approaches to sexual and reproductive health education that engage families while respecting adolescent confidentiality; capacity-building for feldsher-midwife posts and rural primary care teams who are often first-contact providers; and alignment with medical education reforms at Tbilisi State Medical University and other institutions. The framework’s emphasis on transition from paediatric to adult care is particularly relevant given the fragmented specialist services in the region, and its guidance on telehealth can support adolescents in remote areas of Georgia, Armenia, and Azerbaijan where geography limits access to specialized adolescent health expertise.
Questions this guideline answers
Quick answers
What is the HEADSSS assessment and when should it be used?
HEADSSS (Home, Education, Eating/Exercise, Activities, Drugs, Suicidality, Sex, Safety) is a structured comprehensive psychosocial assessment tool. This framework recommends completing a HEADSSS or similar assessment (e.g., SSHADESS) for all adolescents regardless of presenting complaint, not just those with obvious psychosocial concerns. It allows adolescents to reveal mental health, substance use, violence, or other concerns as part of routine care, enabling early intervention and integrated management.
How should health workers balance adolescent confidentiality with involving parents or caregivers?
Health workers should: (1) spend time alone with the adolescent in each consultation; (2) explain confidentiality and its limits at the start; (3) assess the adolescent's capacity for decision-making individually (not by fixed age); (4) discuss with the adolescent before sharing information with others; (5) involve parents/caregivers as appropriate and in consultation with the adolescent; (6) balance autonomy with developmental abilities and safety; and (7) share information when required by law or when necessary to prevent serious harm, using ethical reporting practices.
What should be included in anticipatory guidance for adolescents?
Anticipatory guidance should be integrated into all consultations and address: normal growth and development; nutrition and healthy eating; physical activity (recommended levels, barriers); sleep hygiene; safe use of digital technologies and screen time; substance use prevention (alcohol, tobacco, drugs); sexual and reproductive health (pregnancy and STI prevention, contraception); injury prevention; mental health and stress management; immunizations (catch-up schedules, HPV, meningococcal); school and learning; and relationships. It should be tailored to the adolescent's developmental level and current behaviours identified through comprehensive assessment.
What are the key steps in transitioning an adolescent from paediatric to adult care?
The transition process should include: (1) assess the adolescent's capacity for self-management using transition readiness assessments; (2) promote self-care skills throughout adolescence; (3) provide education to adolescent and parents about how roles change (from parent managing to supporting autonomy); (4) initiate transition planning early, not at the point of transfer; (5) identify an appropriate adult health care provider; (6) prepare a comprehensive health summary for the adolescent and receiving provider; (7) facilitate handover including verbal and written documentation; and (8) support continued engagement to prevent disengagement during the high-risk transition period. Regular health visits should be encouraged for all adolescents to normalize health care utilization prior to adulthood.
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Quality & accreditation
- Issuer
- World Health Organization
- Type
- Guideline
- Edition
- 1st edition, 2025
- Replaces
- Core competencies in adolescent health and development for primary care providers, 2015
- Status
- Current
- Published
- 2025-10-23
- Languages
- English
- Scope
- Global; pre-service and in-service competency-based education for all health workers providing adolescent health services
- Audience
- Ministry of health and education officials, curriculum coordinators, educators in teaching institutions, licensing authorities, professional associations, medical students
- Licence
- CC BY-NC-SA 4.0 IGO
- ISBN
- 978-92-4-011573-6
- Evidence
- Evidence reviews of peer-reviewed literature (2015–2024), national policy documents, global surveys of adolescents and adolescent health experts, expert consensus via Technical Working Group
- Record history
- Created 14 Oct 2026 · updated 14 Oct 2026 · next check Apr 2027
World Health Organization. Competency and outcomes framework for adolescent health and well-being. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 4.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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