Working With Young Families:

A Framework for Practice

Jody Scanlon, LCSW

Overview: From Theory to Practice

Review of Adolescent/Infant/Toddler Development

Understanding the Dual Developmental Crisis

Preventing Subsequent Pregnancies Utilizing parallel process in our work Pulling it all together

Stranger in a Strange Land

Our work asks us to visit a foreign culture Customs, language, world views are

unique Enter with respect Learn to speak the language Maintain sense of self

Here’s the Problem:

Teen years are no longer a convergence of puberty (physical maturation) and what we have termed adolescence (psychological maturity)

Teens now have physical capacity for reproduction long before they have emotional maturity for parenting

A Nod To Neuroscience

Adult decision-making and reaction utilize frontal lobes primarily

Adolescents often are accessing the amygdala (temporal lobe)

This explains a lot!

Adolescence: A Conceptual Framework

Erickson divides human development into discrete tasks to be accomplished during each stage

Task of adolescence is identity formation—critical in understanding teen pregnancy

Stage 1: (10) 12-14

Movement toward independence Peers replace parents as primary relationship

and source of information Actions take precedence over thought Over-riding need for immediate gratification Minor rule-breaking and experimentation while

still tied into rules and expectations of parents

Stage II: 14-17

Increased intensity of individuation Increased conflict with parents Heightened narcissism/grandiosity/sense

of invulnerability Increased risk-taking/impulsivity More abstract thinking

Stage III: 17-19 (25)

Firmer sense of identity Interest in career development (crucial to

support this) Independent decision-making Increased regulation in emotional states

and insight

Statistics tell us that the preponderance of teen pregnancies are unintended (80%) however, there is a significant amount of ambivalence— “if it happens, it happens”

From a teen’s perspective, some legitimate reasons

Attention and care from pregnancy

Let’s Add Teen Parenting to the Mix

Erroneous belief that FOB will stay (less than 20% result in marriage)

Psychologically—opportunity to provide the parenting she never had

Identity formation

Adolescence + Teen Parenting

Now on to Infant Development

Infants need to develop a sense of trust first and foremost

Require dependability from a primary caretaker

Require that their needs are seen as primary

Require stability and predictability

And Toddler Development….

Sense of safety so that they can explore the world

Emotionally labile (temper tantrums) Conflict between

dependence/independence Narcissism Invulnerability and risk-taking through

experimentation

The Dual Developmental Crisis

With infants: adolescents’ needs are in direct opposition to the infants’ needs

With toddlers: both the adolescent and the toddler are experiencing similar developmental stages simultaneously

Adolescence is in many ways a recapitulation of toddler years: push/pull, approach/withdraw

Desire for independence and need for security and parental guidance

So, A Teen By Any Other Name….

Is still a teen And a mom Important for providers to work on both

levels Interventions are usually most successful

when we put the teen before the mom

Preventing Subsequent Pregnancies

25% of teen moms will experience a subsequent pregnancy prior to age 20

From an adult perspective: this defies logic!

Teen moms know first hand the hardships

Why, Why, Why?

Common Reasons given: Spacing of children New boyfriend Desire of FOC Complaints about contraception Nostalgia for infant phase Whoops!

Reasons Behind the Reasons

Competency: I can do this! Lack of future orientation Pregnancy was a time of care and support Lack of efficacy re: family planning

Characteristics of Effective Interventions

Long-acting, low maintenance method Involvement during first pregnancy Sustained relationship with client Close, high-quality relationship with client

IUDs and Adolescents

American College of Obstetricians and Gynecologists (2007):

Because adolescents contribute disproportionately to the epidemic of unintended pregnancy in this country, top tier methods of contraception including IUDs ..., should be considered as first-line choices" for them. "After thorough counseling regarding contraceptive options, health care providers should strongly encourage young women who are appropriate candidates to use this method."

Home Based Contraception

Partnership with Boulder Valley Women’s Health Center

Provides Depo Provera shots to GENESIS teen clients in convenience of their homes

Eliminates barriers Increases opportunities for case

management

Parallel Process

BabySupervisor Caseworker Teen Mom

Working With Parallel Process

Parallel Process can teach us a lot about what is going on in the mother/infant dyad

Be aware of what you are feeling when with a client

This might be a reflection of what she is feeling with her infant

And, ultimately, what the infant is feeling

Use this information to guide interventions Anxiety, dependency, ambivalence, avoidance These clues also appear in the course of

supervision Awareness of parallel process enriches

therapeutic and supervisory relationships and can result in more effective interventions

Some Techniques

Speak to the ambivalence Be curious! Work to understand the teen’s motivations Empower the teen—they know better than

you how they can change and what will work in their lives

Remember Developmental Issues

Work with not against their narcissism—it is developmentally appropriate and not a character flaw

Becoming moms does not make them adults—they don’t necessarily think like we do

Their brains are not fully developed—help them to see beyond the immediate and to recognize consequences of actions

Create Safety

Be genuine Avoid the very real temptation to be

parental Always explain the rules up front Change is scary and it is hard Teens will respect you for setting limits—it

might be the first time that anyone has done this for them

Use Supervision

This is where the parallel process is likely to play out—pay attention—and use these clues

Watch for burn-out and secondary trauma Plant seeds and have faith they will grow Celebrate successes—no matter how “small” Remember your limits Find ways to transition back home

Build a Future

Be a cheerleader—you might be the only one who has ever believed in them

Be a role model Be calm Cool, And collected when they are acting out

(remember the parallel process—it’s what you might do with a toddler and a temper tantrum)

When You Feel Stuck….

Listen to the music, not the words Avoid the temptation to “fix” Always start with the assumption that

EVERY parent wants to be the best parent they can be—our job is to reinforce this natural inclination

“Challenging clients”—what are they teaching you?

Remember Systems Theory

Ripple effect of our actions Teen is part of a system larger than

herself Respect the power and significance of

family, friends, environment Work organically within the system

It’s All About the Relationship

Relationship is key to facilitating change Read cues and pace accordingly Respect boundaries—teens put them there for a

reason Patience Don’t give up—they may be testing you because

they expect you will not stay with them You may be the first and only person in their life

to model a healthy relationship

Remember:

We make a living by what we get; we make a life by what we give.

--Dr. Albert Schweitzer

Life Enrichment