Working With Young Families:

A Framework for Practice

Jody Scanlon, LCSW

Overview: From Theory to PracticeReview of Adolescent/Infant/Toddler DevelopmentUnderstanding the Dual Developmental CrisisPreventing Subsequent PregnanciesUtilizing parallel process in our workPulling it all together

Stranger in a Strange LandOur work asks us to visit a foreign cultureCustoms, language, world views are uniqueEnter with respectLearn to speak the languageMaintain sense of self

Heres 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 primarilyAdolescents often are accessing the amygdala (temporal lobe) This explains a lot!

Adolescence: A Conceptual FrameworkErickson divides human development into discrete tasks to be accomplished during each stageTask of adolescence is identity formationcritical in understanding teen pregnancy

Stage 1: (10) 12-14

Movement toward independencePeers replace parents as primary relationship and source of informationActions take precedence over thoughtOver-riding need for immediate gratificationMinor rule-breaking and experimentation while still tied into rules and expectations of parents

Stage II: 14-17

Increased intensity of individuationIncreased conflict with parentsHeightened narcissism/grandiosity/sense of invulnerabilityIncreased risk-taking/impulsivityMore abstract thinking

Stage III: 17-19 (25)Firmer sense of identityInterest in career development (crucial to support this)Independent decision-makingIncreased regulation in emotional states and insight

Lets Add Teen Parenting to the MixStatistics tell us that the preponderance of teen pregnancies are unintended (80%) however, there is a significant amount of ambivalence if it happens, it happensFrom a teens perspective, some legitimate reasonsAttention and care from pregnancy

Adolescence + Teen ParentingErroneous belief that FOB will stay (less than 20% result in marriage)Psychologicallyopportunity to provide the parenting she never hadIdentity formation

Now on to Infant DevelopmentInfants need to develop a sense of trust first and foremostRequire dependability from a primary caretakerRequire that their needs are seen as primaryRequire stability and predictability

And Toddler Development.Sense of safety so that they can explore the worldEmotionally labile (temper tantrums)Conflict between dependence/independenceNarcissismInvulnerability and risk-taking through experimentation

The Dual Developmental CrisisWith infants: adolescents needs are in direct opposition to the infants needsWith toddlers: both the adolescent and the toddler are experiencing similar developmental stages simultaneouslyAdolescence 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 teenAnd a momImportant for providers to work on both levelsInterventions 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 20From an adult perspective: this defies logic!Teen moms know first hand the hardships

Why, Why, Why?Common Reasons given:Spacing of childrenNew boyfriendDesire of FOCComplaints about contraceptionNostalgia for infant phaseWhoops!

Reasons Behind the ReasonsCompetency: I can do this!Lack of future orientationPregnancy was a time of care and supportLack of efficacy re: family planning

Characteristics of Effective InterventionsLong-acting, low maintenance methodInvolvement during first pregnancySustained relationship with clientClose, high-quality relationship with client

IUDs and AdolescentsAmerican 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 ContraceptionPartnership with Boulder Valley Womens Health CenterProvides Depo Provera shots to GENESIS teen clients in convenience of their homesEliminates barriersIncreases opportunities for case management

Parallel ProcessBaby

Working With Parallel Process

Parallel Process can teach us a lot about what is going on in the mother/infant dyadBe aware of what you are feeling when with a clientThis might be a reflection of what she is feeling with her infantAnd, ultimately, what the infant is feeling

Use this information to guide interventionsAnxiety, dependency, ambivalence, avoidanceThese clues also appear in the course of supervisionAwareness of parallel process enriches therapeutic and supervisory relationships and can result in more effective interventions

Some TechniquesSpeak to the ambivalenceBe curious!Work to understand the teens motivationsEmpower the teenthey know better than you how they can change and what will work in their lives

Remember Developmental IssuesWork with not against their narcissismit is developmentally appropriate and not a character flawBecoming moms does not make them adultsthey dont necessarily think like we doTheir brains are not fully developedhelp them to see beyond the immediate and to recognize consequences of actions

Create SafetyBe genuineAvoid the very real temptation to be parentalAlways explain the rules up frontChange is scary and it is hardTeens will respect you for setting limitsit might be the first time that anyone has done this for them

Use SupervisionThis is where the parallel process is likely to play outpay attentionand use these cluesWatch for burn-out and secondary traumaPlant seeds and have faith they will growCelebrate successesno matter how smallRemember your limitsFind ways to transition back home

Build a FutureBe a cheerleaderyou might be the only one who has ever believed in themBe a role modelBe calmCool,And collected when they are acting out (remember the parallel processits what you might do with a toddler and a temper tantrum)

When You Feel Stuck.Listen to the music, not the wordsAvoid the temptation to fixAlways start with the assumption that EVERY parent wants to be the best parent they can beour job is to reinforce this natural inclinationChallenging clientswhat are they teaching you?

Remember Systems TheoryRipple effect of our actionsTeen is part of a system larger than herselfRespect the power and significance of family, friends, environmentWork organically within the system

Its All About the RelationshipRelationship is key to facilitating changeRead cues and pace accordinglyRespect boundariesteens put them there for a reasonPatienceDont give upthey may be testing you because they expect you will not stay with themYou 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