Working With Young Families:

1
Working With Young Families

• A Framework for Practice
• Jody Scanlon, LCSW

2
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

3
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

4
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

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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!

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Adolescence A Conceptual Framework

• Erickson divides human development into discrete
  tasks to be accomplished during each stage
• Task of adolescence is identity
  formationcritical in understanding teen
  pregnancy

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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

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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

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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

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Lets Add Teen Parenting to the Mix

• 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 teens perspective, some legitimate
  reasons
• Attention and care from pregnancy

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Adolescence Teen Parenting

• Erroneous belief that FOB will stay (less than
  20 result in marriage)
• Psychologicallyopportunity to provide the
  parenting she never had
• Identity formation

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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

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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

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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

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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

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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

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Why, Why, Why?

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

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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

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Characteristics of Effective Interventions

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

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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."

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Home Based Contraception

• Partnership with Boulder Valley Womens Health
  Center
• Provides Depo Provera shots to GENESIS teen
  clients in convenience of their homes
• Eliminates barriers
• Increases opportunities for case management

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Parallel Process
Baby
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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

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• 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

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Some Techniques

• Speak to the ambivalence
• Be curious!
• Work to understand the teens motivations
• Empower the teenthey know better than you how
  they can change and what will work in their lives

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Remember Developmental Issues

• Work with not against their narcissismit is
  developmentally appropriate and not a character
  flaw
• Becoming moms does not make them adultsthey
  dont necessarily think like we do
• Their brains are not fully developedhelp them to
  see beyond the immediate and to recognize
  consequences of actions

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

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Use Supervision

• This is where the parallel process is likely to
  play outpay attentionand use these clues
• Watch for burn-out and secondary trauma
• Plant seeds and have faith they will grow
• Celebrate successesno matter how small
• Remember your limits
• Find ways to transition back home

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Build a Future

• Be a cheerleaderyou 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 processits what you might do with
  a toddler and a temper tantrum)

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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
  beour job is to reinforce this natural
  inclination
• Challenging clientswhat are they teaching you?

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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

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Its All About the Relationship

• Relationship is key to facilitating change
• Read cues and pace accordingly
• Respect boundariesteens put them there for a
  reason
• Patience
• Dont give upthey 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

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Remember

• We make a living by what we get we make a life
  by what we give.
• --Dr. Albert
  Schweitzer
• Life Enrichment