rsi rtia

A REPORTOF A COUNSELLING INTERNSHI P AT THE ADOLESCENTHEALTHCOUNSELL INGSERVICE INCLUDING AN EVALUAT IONOF THE PARENTING PROGRAMNOBODY'5 PERFECT FORUSE WITH ADOLESCENTPARENTS

BY

Ruth M. Mandville,B.A.(Ed), B.A.

Arep ort submit ted toth e Schoolof Gradua te Studies in partial fulfillment of th e

requtre me n e s for the degr eeof Master of Educa t ion

Fac ul tyof Education Memoria l universi tyofNe wf o u nd l a n d

May, 199 2

St.Jo h n's Newfo un dland

1+1

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TABLE Of CON'l'ENTS

Abstract .

Acknowledgements .

List of Tables CHAPTER

INT RODUCT I ON

Setting .

Duration .

Superv ision .

Goals of the Internship .

II ANALYSIS OF'THEINTERNSHIP ••••••••. ••••••••

Introduct ion .

pe qc tv

vi

orientation .

Individual Counselling... .... . 10

Peer counselling... ... ... 11

Group Guidance ... . . ... ... ... ...• . 12

Fa mil ycounsell ing •. ... . .. . ... .... 12

CityAgenc ies...•... ... .. . ... . .. 13

Case Re vi ews ...•. . . .... ... ... ... . ... . 15 Wor ks ho psISe mi na r s 16 workingwithStaff ... ... 16

supervisi on ... .. . ... . ... . .... . . ... 18

Educa t ionalSessions 20 Summar y ...• . •. .. .. •.. . .. ... ... . . . .• 20

III RESEARCHCOMPONENT ••• ••• • • ••••• • • ••••• ••• •• 22 Introduction ... ... . ... . .. . ... . . .• •. •.. 22 Need for the. Study ... . . .• •..•'.'.••.•••.• 22 Purpose of th e Study •••••••••••••••••••• 25 Revi ewof theLi t e r ature ... .. . ... . . . 26 Groups for Adolescents .•••• •. • •.• • ••• 27 Adol escen tParentsandtheirCh i ld re n. 31

Th e Adolescent Fath er. . .•.•...• •• • Parentin g progra ms for Adolescen t s ... 36 Nahady's Perfect Pa r e nting Program. .. 45 Otfer Sel f-ImageQu es tionna i r e ... 48 Summary.. ... ... . . .. ... . . ... . . ... 51 Methodology ...••.• •• ••• •..• ••• ••• •.••. .• 52 Introduc tion ... ... .. • .... . 52 Pro gram Desc ri pt i on .•. ..•.••••••••..• 53 popu La t.Lon••••• •• •••• ••• •••••••••.•• • 55 Resea rchQues tions ...• . ... . 57 Inst rume nt at ion... .. .. . ...• ••••.. .. 59

Procedur e 67

Descript i on sof Se ssi o ns 68

Summa ry.. . . ...• •..• 69 Li mitat i ons of the Study .. ...•.. 69 Findingsofthe St ud y •••••• •••• ••••• ••• • 73 Ove rvie w.. ...•.. • . .. ...•. .. 73 Ge ne r al Demoqraphic Informatio n 74 Indivi dual Profiles

i l

75

Discussion of the Findings.• •... ..•... 100 Summ<'llry... . ..•.. ..•.••.• •... • . ... . .•. IV SUMMARY ANDRECOMMENDATIONS... ... t2l

Objecti vesandActi v i t i e s .•.... . . ..•.•• .

aeeea r ch Find i ngs .

Recommen da tions ..•.. ••• •. ...•...•..•. . 125

REFERENCES••.•.•••.•• •... .... ..•.•... ..•.. .•. •• 130 APPENDIX

Le ar n i ng Contract .•.• . ..•..•••. ... .•• .•.•.• 134 Li s t of BooksRead During the Internship •.• 138 Questionnaires for the Ev a luat i onof

th e Nobody's Perf e c t program .. ... . ... .. . 140 The Offer self·lmageQuestionnai re for Adolescents.. .. ... .... .. . .... . . ... 196 Summary Tableof the Sex, MaritalStatus, At te n d a nc e at Sessionsand Evaluationof Participants in the Nobody's Perfect

parenting Program... .. .... .. 20S Registration Form for Participants in tho Nobody's Perfect program.. .... .. ... . .. 207 Descriptionof Group Sessions for the Nobody's

~ParentingProgram. ... .. . .. ... .. 209 SummaryTableof ParticipantsI Attendanceat NobodyIs Pe~Sessions... . .. ... .... 217

iii

ABSTRACT

This report describes an internship comple t e d at the AdolescentHealth Co un s e l l ing Servi c e,May 6 throughAugust 2, 199 1. It includes acomprehensive rep or t of thegoals and the pr o f e s s i onal ac tiviti esof the internduringthe inte rnshi p period. Inaddi tio n, it presentsa detaileddiscussio nof an evalua tio nstudyconduc t e dduring the internsh i p.

Thede scr ipt i on of the inte rnsh ipincl ude s the rat ionale , adescript i o nofthe setting, the goalsof the int ernshi p , its dur a tio nand a description of the supervis ionof the int e rn duri ngthe inter nshi p. A comprehensiverepor tofthe int ern 's prof e s s i o na l activities accor ding to the goa l s of the interns h ipispr esented . There s e arc h project, itsrationa le, des cr i pti on and limita tio ns are des c ri bed. The pr o j ec t cons ist e d of an as s es s ment of th e effective ness of the parenti ngprog r amNo body' s Pe r f e c t (AtlanticReg ional Health Promotio nal Commi t t e e, 1989) for use ....ith ado lescent parents.

Throughindividua l analys i sa determina t io n of thepr ogra m' s effect onpa r t ic i pan t s ' kno .... ledge, attitudes,andbeha viour in relation to their ch ild ' s health , saf ety and behaviourwas made. The st Udy showed mixe d re sul t s forparti cipants, but demonstrated pr omisefor more widesp read useofthe ~

~programamong adole s c ent s. Therep o r t ccn c judeswith asumma r y and ase t of re co mmendat i on s for fur therstUdy .

Iv

;"CKNOWLEUGEMENTS

I am thankful to se ve r a l people who have contributed time,etfortandsupportin helpingme completethisproject.

I wis h to thank Dr. David Watts, my departmentalsupervisor, for taking on the task and for hi s re l entless guidance throughout the in t e r n s hi pperiod and especially du ring the writingof thisreport. In addition ,a specia lword of thanks to Dr.Lee Klas fo r his ass i stanc ein the final pr e p a r a tio n of thisreport.

Tha nksare alsoextended to thest a f f of the Adolescent Health Counselli ng Servi c e , in particul ar , Ja me s Oldford, for their support.

Thanks, as well to Katherine Ell i o t t forher technical assistance in the writing of this report.

Finally, a special thank you tomy family and friends ....ho always understood and who were a constant source of support for me throughoutthe entirety ofth i s program .

Table 1.

Tabla 2.

Table 3.

Table 4.

Table 5.

Table 6.

Table 7.

Table 8.

Table 9.

Table 10.

TABLES

comparison of pre and post program responses regarding parental knowledgeof health and safety it ems for SUbject"A".

A comparison of the pre and posttest scores of the Offer self-ImageQuestionnaire for SUbject

"A".

comparison of pre and postprogram responses regarding parental knowledgeof health and safety items for SUbject"8".

A comparison of the pre and posttest scores of the Offer Self-Image Questionnaire for SUbject

"B".

comparison of pre and postprogram responses regarding parental know ledge of health and safety items for Subject"C".

A comparisonof the pre and posttest scores of the OfferSelf-Image Questionnaire for SUbject

"C".

comparison of pre and postp rogram re spon s e s regarding parental knowledge of health and safety items for SUbject"0 ".

A comparison of the pre and posttest scoresof the Offer self-Image Questionnaire for SUbject

"0".

Comparison of pre and postprogram re s p on s e s regarding parental kncvLe d qe of health and safetyitems for SUbject "E".

A ccnperIs c n of th e pre and posttest scores of the Offer Self-Image Questionnaire for SUbject

"E".

vi

CHAPTER 1 Introduction

ca ndrdetes for the Master of Education de gr e e are required to complete ten approved courses and a thesis, pro j e c t or inter nship to fulfil their academicreq u i r e ment s. Theinternshi pis a thirteen-weeklongsupervt eedplacement at anapproved setting. It is intended to provide the int er n with an opportun i t y to enhance the skills which have been developed through course workand training duri ngthepr ~!vious year.

An in t e r n s h ip was considered an ideal option for th e fu lf i l me nt of the Masterof Educ ationrequirements. It would provi de, under supervision. an excel lent opportunity to enhancethe counsel lingslcills currently possessed. It would also allow the inter n to delve intoan area ofinte r e s t and limi t e dkno wl e d ge (thatis , family cou n s e ll i n g ) and give the intern thech a n c eto develop skills in that area. Timeatthe internship would provide exposure to a broader multi- discip li nar y ap proach than likely to be seen in a school setting. However, skills and knowledge gainedwould tra ns fe r nicel y to th e rol e of school cou ns ellor. fina lly, the internshipwouldpro v i d e valuableexposureto variousagencies pro v i d i n g services to adolescen ts. This would be of tremendous benef it for the intern's work as a scho ol counsellor.

Setting

TheAdolescen t HealthCounse llingServicein St.John's , Ne wfo und l an d, was chos en for the inte rn s h i p setting. The se rvice is a fre e st a ndi ng sa te lli t e of the Janeway Child HealthCentre inSt .John 's,Newfoundla nd, Ca nada . sinceits ope ningin March, 1984, it has pr ovi dedservi c esto over1400 adoles centsandtheir families. Mr. Jame s Old fo r d(Ii.S.W.)is the direc tor or me ntal healt h ser v ice s at the Adolescent HM.lthcounse ll ingservic e . Ms.Clau d e t t eBoyd (M.Ed)directs the areas of Lif est y l e and Growth and Development. Mr. Oldfo r d and Ms. Bo yd compri se the full-t i me professional staf f . In add it i o n,therearese ve ra l part-timecounsellors who spen d vary i ng amounts of timeat the Adole sce nt Health counse ll i ng servi ce . The sepeopl e inc ludea pediatrir.:ian, an ed uc a t i ona l psycholog i st ,a psychiatricnurseandthree social wo rke rs. Thesefull and part-time sta ff consu l t regularly on cases and parti cipate in bi we e k ly cas e rev iew s. The Servi ce has, in the past, traine d st ude nt s frommedici ne , nursing, psychology, ed uc ati ona l psycholog y and social work (J . Oldford, persona l communication, May , 1991 ).

The goals of theAd o l e s c e nt Hea lth Counsel lingService (1991) are:

1. To enhancethe presentand futur e healthof adolescents. 2. To demonstratea model of service

delivery for providinghealthco unsel lingfor adolescents.

3. To facilitate co-o pe r a t ive relationships amongre l e va nt professionsand agencies onthe behalfofadole s c e nt s.

The philosophy of the Serv i ce is tha t adolescence is a critical period for the deve l op ment of attitudes, behaviour and responsibility. The maj or determinants of adolescent healthstatus aregrowthand development,lifestyleand mental heal tho Th e s e determinan tsare affe ctadby the individual's family, pe e r s and education. Healthservi ces fo r adolescents, therefore, must strive toposi ti ve l y in fl uence adolescents' presentand futurehealth. Incarry ingout its mandate,the Service recognizesthe benefitsof cLo se contactwith other ag e nc i e s an dst rives to coo perate with these agen ci e s (The Adolesce nt Healthcounse lling se r v i c e ,19YI ) . Referrals come from manysources, inc l udingsc h ool guid a nce cou nsellors. At th e time of the internship there was an eig ht- ....eekwaiti ng list for servi ces (J. Old f ord, personal comm unicati on, May 1991)•

Duration

The internship commenced on May6, 1991 and continuedfor thir t e e n weeks, ending on August 2, 1991. Th e service was open Monday through Friday from9:00 am to 5:0 0 pm. Th e intern also us e d the building for her group on Tu esday eveni ngs. The grou pmet from 7:00psm,un t il 9:00 p.m.•

Supervision

On -si te supervision was co nd uc t e d by James Oldfo r d :-1.S.W.. Th e inte r n 'sun!verstty supervisorwas DavidWatt s , Ed.D. (DiVisio n of Educational Psychology, Facul ty Of Edu cat ion ) •

Go alsoE th eIn ter nsh ip

Thema i n ob j ect ive tortheinternship wastoenhance the skil lsand competenc ies of thein t er nand prov ideexposure to counsellingservices in a non-senec a setting. A listof goals Was Eo rm ul at ed to meet,this obje c t i v e.

Goal 1: To becoll\e Eamiliar with th", Adolescent lIeal t h Cou nsell i n gService, itsgoal s and philo sop h y , as well as its op e r a t i n gpro c e du re s.

Thi s was acco mpl i sheod byme etings with thedire ct or of mental health an d the se c re tary at the Adolescent Heal t h Coun s e ll ing Serv i ce and th rou g h read ing prin te d mater ia l availableat the servic e .

Goal 2: To carr y a mi ni mumcasel o ad of fi ve cl ie n t s for in d i vidua lcoun selli ng. The s e clients' nee d s wi l l varyand cov e r ara n geof presen t i ng prob l e ms.

Thiswas ac c omplished by exam ining thewai t list at the Adole s c e ntHeal th counsel l i n g ser vice. withth e permissionof the Ma n a gement commi t t e e of theAd o l e s cen t HealthCOUnselli ng Serv i ce the intern wasab l e to take fr o m the lis t referra ls whichcove r edawid era n g e of prese ntingproblem s . The intern workedwitha tota l of twe lvecli e nts duringthe internship. Go a l 3: To beco meinv o l ved 1n and ramlli ar with thePeer cou n s e ll i n g progra mpresent l y in pl ace at th e Adolesc e n t Heal t h Counse l lingSer vice .

Th i sgoalwas reachedthr o u gh contactwithBarbaraKel ly, th e Peercounsell i ng co o r di n a t o r, and through reading re l e va n t

documents. A peer counsellor, Jason, provided informationas well.

Goal 4: To co-lead and evaluate a six week program for adolescent parents/prospective parents.

The parenting program Nobody's Perfect was organized, facilitated and evaluatedby the intern during the internship.

Goal 5: To become familiar, through reading current literature and through experience, with the theory and practice of family systems counselling. Di r e c t contact with a least three families should be made during the in ternship.

This goal w,as achieved through reading five book s on family therapyand throug hdiscussions with supervisors. The internhad contact with eight familiesduring the int ernship. Goal 6: To come intocontact and be familiar withat least five city agencies ....hich offer services to adolescents and their families.

The intern contacted five city agencies and spent from one to t ....o hours visiting each one. A sixt h agency made contactwiththeint e r n .

Goal 7: To participate in bi-weekly case revie...s and to presentat lea st one ca s e.

The intern atte nded and participated in the five case revie....s which too kplaceduring the int e r ns h i p. At one case reviewthe inte rn rrese nteda curre nt ca s e for dis cu ssio nand consultatio n.

Goal 8: To at.t.en d re l e van t workshops/seminarsth a t may be

availableto increaseawareness, knowledge and training. This goal was accomplished by attending the Spring Confere nc eof the Associationof Newfou ndlandPsychologists (ANP) and a four-daytr a iningprogramforthefacilita tionof the paren t i ngpr ogra mNo body ' s Perfect .

Goal 9: To wor k with professionals from differe nt fie l ds (th a t is, Socia l Wor k and Medicine) in orde r to broaden kno w-ledge andenha nc esk i ll s .

During the inte rnshi p the inte rnwas ab le tocons ult on a regular basis, thro ugh bi-wee k l y case rev i ew s, wi t h a ped i a t r i ci a n , three socia l workers,and a psychia tri c nu rse.

In addit i o n ,se ve r a lof the se peopl ewereavai labl eona daily ba s i s fo r cons ulta t ion. Th e inte rn wasableto obser ve two socia l worke r s in co un s el l i ng sessions.

Goal 10: Tovide ot a pe (oraud Lotape] counsel lingsessions for revi ew by the int ern field supervisor, and un i versity supervis o r .

Thro ugh the use of a one - way mir ro r the intern video t a pe d se s s i o ns whenever the client was wi ll i ng and the equ ipm e ntand roomwere avail ab le. All tapes wererev iewedby the intern ; pa rts of all tapeswe r e reviewe d by the field supervi sor.

Goal 11: To consul t wee k l y withthe field supervi sor,James Ol d fo rd ,on prog res s and cas es.

To ac co mp lish this goal , the inte r n and the fi eld sup erv i sor sched uled two-hou r ses si on weekly for

consul tati on. Daily in f o rma l cons u l tat i on s alsooc cur red. Goal 12: To consult we ekly with the inter n's unive rs ity su p erv i s o r, Dr. David Watts , on the inte r nshi p and the in t e rn 'spro q r ess.

Th i s goalwa s partially acco mpli s hed by five meetings withthe int e r n ' s universitysupervisor.

Goal 13: To developandpresen teducat i onalsessions/p ackages on re l e va n t adolClscentissue sforthe purposeof communityand prof essional educ a.t i o n.

To accomplish this goa l, the Interneae Lat.ec the field super v i sor in thepr-e pe r a t.Lc nand presentatio n of a wor k sho p for Ch ild Protection Workers. In addition, th e in te r n accompaniedthe field supervisor to th e JanewayChildren 's Hospita l where thesu pe rvis or gav e a pre sentat ionondating violenceto a grou p ofphy s i c i ans .

CHAPTER II ANAL'{S IS OFTHEINTERNSH IP

Int roduction

Duringthe first weekofth eint e r ns h ipat the Adolesce nt Health Co u ns e lli ng serv ice, together \<Jith th e field supervisor, Mr. James Oldford, the coordinator for mental health at the Adolescent Health Counselling service, Learning Co ntra c t for the duration of th e internship was formulatod . Thiscontract included the desiredgoa lsforthe int ernship. (Th e s e goals are outlinedin ChapterOn eof this report andin Appendix A).

Th i s chapter willanalyzetheinte r ns h i pcomp l e t e d at the AdolescentHe alt h counselling Servicebetween May 6, 1991 and Augu s t 2, 199 1 and will do so by attempting to describe the extent to which each of the thi rt e e n stated goals for the internshipwere met. Each goal will be statedand followed by an explanat ion ot'che activities pursued in an effort to attainthat particula r goal. Forclarity, the thi rtee ngoals are group under elevenhe a ding s Which inc l ud e: orientatio n, individual counselling, peer counselling, group guidance, family couns e l l ing, city agenc i e s, reviews, workshops/semina rs, worki ng with staff, supervi sion and educationalsessions.

orientatio n

Goal 1: To become familiar with the Adolescent Heal t h Co unsell ing Serv ice, its goals andphilosoph y , aswe lll.'!Sits operatingprocedures.

The first week at the Adolescent Hea l t h counselling Service was spent as an orientat ionwiththe serv ice itself, the staff, the goals and philos ophy of the AdolescentHealth Counselling service and the general operating procedures.

Muc h of the orientation was achieve dthrough the readingof the orientationpackageWhich included a policyand procedure manual. These doc umentsprovidedan over v iewof the history, goals and philosophy ofthe service. Thispackage gave a very good understandingofthe serv iceandhow itevol ved.

Ja me s Oldford , (M.S.W. ) ,the directo r of mentalhealth at the Adolescent HealthCounsell ing se r v i c e , met withthe intern during the first week of the internship to discuss intake procedures and the forms used for intake, as well as the referral forms used at the Service. By the end of the first week Mr. Oldford and the intern had worked together to formulate a Learning Cont ract for the inter ns hi p. (Se e Appendil{ A). Thisdocument includedgoa lsfor the internship, the intern's duties while at the se r v i c e and Mr. Oldford's responsibilitiesas field supervisor.

The secretary, Carol Rice , was ve r y he Lpfu L in the or ientationas she fami liarized the inte rnwith generaloffice procedure and locationof files. Th e orientat ion at the Adolescent Healthcounselling service was comp l e t e d inthe first week.

10

IndividualCounselling

Goa l 2: To carryaminimum case Icedof five clients for indi vidua l counselling. These clie n ts ' needswil l va ry and covera range of prese ntingprob lems.

Du ring the internship the intern had occasion towork with twelve clien ts. Each of th e s e twel v e was seen individuallyand eight of the twelve werealso se en wit h at least one familymembe r.

The number of sessionswith eac h client range dfr om one session to nine sessi o ns, Themodalnumber of sess ions was five ; theave rage numberofse s s i o ns was four per cli e nt.

Threecli e ntscameto onlyonesessionand didnotre tur n for SUbsequentsession s . One of the s ewas a young manwh o was living ina group ho me andwas mo ve dtoa foste r homeoutside th e cI ty. Anot he r was a youn g ma n who missed se ve r a l appoi nt ment s befor e he fina lly came in with hi s mothe r. Thoug h he agreed to come back, he cancelle d the next appointment bec a us e of othercommitments. Efforts toreach th e family were futi le unt il the secon d last week of the interns hi p. By thisti me, the you ngmanwasattendingsummer camp. This case wa s referr e dtoMr. Oldford whowill se e the family if the y ca llbackat alate r date. The th i r dCli ent , who was seenonl y onc e, was ase vent e e nye a r oldma le. This man misse dthree sch eduledappoi ntmen ts be for e heatte nd eda counselling session. He then mi s sed two mo r e schedu led appointments. Whe n finall y con tac t e d by phone he repor ted

11

that he was "too bUsy" to attend additi onal counselling sessions.

Other clients were seen for var yi ng numbers of times.

Onecli e n t and her family had a total of ninevi s i t s; another had six .

The presentingproblems of thetwelveclients seen during the internship were varied. They included the problem of parental control, self-esteemissues, abusive re l a t i onships , trouble withthela w , dealinqwith parents' div orce,dealing with parental iLl ne as e s, past depre s si on and general adolescentissues .

Eightof the twelvecasesseenwere terminated before the in t e r n left the AdolescentHealthcou n s ell i ng Service. Four were referredto Mr. Oldfordfor furtherco u nse l l i ng .

Peer Counsell ing

GoalJ: To becomeinv o l ved in and fll.lll il iarwithth e Peer counselling program presently in place at the Adolescent Health Counsellingservice.

Thi s goal was only partially reached. The Peer counselling Program operated out of anot her building in st.

John's. Therefore, the intern was not able to have frequent exposure to the program or contact withthe coordinator. The inter nvisited the siteof the PeerCounselling Program on one occasion, and had a discussion wi t h Barbara Ke lly , the coordinator of the program. Ms. Kelly provided the in t ern withinformation about the Peer counselling Program, howit

12 op eeoe ce and howto mak e ref erra l s to the pro gram. A peer cou ns ell or ,Jason, al so pro v ide d informa t i o n .

GroupGu id a nee

Goal 4: To co-le ad and evalu ate asixwe e k programfor adoles centparents /p r ospe ctive pare nts.

Dur i ng the in t e r nsh i p the int e r nco- led th e pa r e nt i n g pr og r am No body's Perf ectfor a groupofadol e scent mothersand fathe rs. Th i s was par t of the research component of the Irrcernshtp. The rese a rch inv o lved the eval uat ion of the pare nting pr ogramwith adolescent parents. Th i s study is describedin detail in Chapter Three .

In order to obt a i ngroup members,sixteencityagencies we r e co n t ac t e d by tele p hone and foll owe d up with an inf o r ma t i o n le t t e r de s cribing the program and appropriate cl i e nts for referra l. Prior to the first sessio n, seven cli e ntsmade commitmentstoatt e nd. This groupof sevenwere administeredpreprogramquestionna iresto elicit information related to evaluationof the program. The programconsisted of six weekly sessionsbeginningon .rune 25, 1991and ending on July 30, 1991. Five members of thegro up completedthe program. The s e members were administered the postproqra m questionnairesas part of the evaluationco mponent .

FamilyCounsel li n g

Goal 5: Tobecome familiar, through rea d i ng cu rren t literature and through experience, with the theo ry and practice of family systems counse lling.

13 In an efro rt to ful fi ll thisgo al th e inte rn utilized thre emethods - re adi ng, di s c u s s i ng and supervise d practice . Books andjour nal articles on fa mi l y syst ems theorywere read. A list ofth es e re ading s can be found inApp end i xB.

Some superv isi ontillle....asspe n tdiscuss!nq fami lysyst(!ms theo r ywith bot hsu pe rvisors. Exposureto systemi cthink i n g was al so ach i e v e d throu qh bi- we ekl y e aee rev iews where dit fe r ent familycaseswere present ed anddiscus s ed.

Family systems theorywas put intosupervise d practice . The inte rnworkedwith eightfamili es durLnq the interns hip.

She was directlysuperv is e d wit hone of thos e families and ma d e vid e otapes of the ot h e rs for di scus si onwith her field sup e rvi s or.

CityAg e n cies

Goal 6: To come int o conta ct and be famil i a r wit h at least five cityagencies whichof fer services toadol es cents and their falllilie s.

Dur i ng the inte rnship the inte rn visit e d six ci t y agencies. In each cas e, the intern spent from one to two hou rs at th eagenc y. Whil ethereshebe c ame familia r\.lit hth e agenc y by conv ersat ions with a dir ectorand , in two cases, received a gui ded tou r of the facility. The tou r gave the inte rn a chance to viewthe facilityand meet st a ff and , in some cases, residentsorstudents.

The inter n had plannedtovi si t five city agencies. The five propos ed sites incl udedThe ~e ad yCcm t r e , The Brot her

14 T. I. MurphyCentre, Iris Kirby House. ElizabethHo us e , and the Alcohol and Drug DependencyCommission.

All but one of th e s esites were visited. During the cours eof the int e rnshi p a decisi onwas madenot to visitth e Alcoholand Drug Dependenc yCommission (ADDC). Some exposure tothe ADOCha d be en accomplishedthrough th egr ad ua teprogram at Memo ri al Univ ersity by wa yof a two-day ins e rv i c e and the r e fo rei twas fe l tth a t itwoul d be be t t e r to usethe ti me visi ti ng anotherag enc y . Cho i c e s forYouth,anewlyorganiz e d progra m designed especi a llyfor adolescentswhohad spe nttime in fosterca re was visi tedinstead. It was felttha t th is org a ni zatio nwasmo re inconc e rtwit h theinte rnISwor kat the counse lli ng se rvi c e and subsequ e n t work as a sch oo l counse llor. RobertFllds ,a coo r d inato r at Choic e sfo r Youth, prov i ded informat ionon theprogr a m.

Mr . Gor d onSpur rel, at theRead yCentre, provided the int e rn wit ha tour of that fa c i lity. The int e rn met several stude nts and two other staff memb e rs. Mr. spurrel als o provide d informat ion on the re f erra l process for the Ready Ce ntre aswell as details concer ning thecur ric u lumprovided at theReady Centre.

At the Brother T.!. Murphy Ce nt r e , Ms. LoisFinnprovided inf ormati on conc ern i ng the centre's cu r ri cu l um and the refer r al precess ee well as a tour of the facility. Susan Sh iner, a co u ns e llo r at Iris Kirby House familiarizedthe int e r n with the philosophy of the wome n's Shelter, its

)5

operat i n g pr oced ureand itsfacilit i es. Theintern WlIoS..ct;

provided withatou r of the facil1ty in aneffort to preserve the anony mityof the residents. while visiting the Br other T. r.Mu rp hycentre , tile internalso met Mauree n Re d dig an. Ms.

Reddig a n is th e coordinator of a peercounselling progr a m ca lledYouthOutre a ch whic hoperates out of the Centr e. Ms. Re ddigan ,alon g with agroupof threetra ined peer coun s e llo r s travel ar ound the city in amot o r home identifyinq th eyouth of th e city who ne ed counselling and ref e r rin g them to appro p riate agen ciesWhe nnecess ary . Ms. Redd iganprovided thein t e rn with ades c rip t i on of the pr og r a m and it s goals.

Theint ern me t with PhilameonaRo dge r s, the direc to r of Eli zabe t h Hous e ,at her of fic e inSt. John's. Ms . Rodgers inf orme d the intern of the ph il os oph y . ope r ating proced ure s and re f e r ra l proc ess of Elizabeth House, ....hich provide s shel te r for young, sing l e , pregnant gir l s. A to ur of the bu ild ing was not und ertaken in an effort to protect the privacy of th e resi de nt s.

Ca s e Rev revs

Goal 7: Topa r ticipat e in bi-wee klycaserevie ws and to presentatle as t on e case.

Ca se reviewswere scheduled bi- we ek ly atthe Adoles cent Health counselli ngServi c eand attended byfull-t i meandpart- timestaff. Whileat the Se rv ice , the inte rnattend ed each of thefiveca s e reviews ....hi ch too k place.

16 Case re v iew was a time for one cr- mo r e couns e llo r s to presenta cas ethey....er ecur re ntl ywo rki ngonforcon sul t ati o n with the ot he r coun s ello r s . On June 25, 1991, the int e r n pre s en t e d such a case for group consu l tation .

wor ks hops /Sem inars

Goa l 8: To at te n d rel eva nt workshops /seminarsthat may be available to increaseawareness, kno wl ed ge and training.

During the internshiptheint e rn attended two workshops.

One was an in format i o nworkshop and one wa s designed for train ing .

On May 17. 1991, the in t e r n attended the spring Conf e r e nc e of theAs s ociat i o n of Newfoundland psychologists (ANP ). Ses sions at the conference covered a variety of topics. Theint e r n attended sessions on cognitive-behavioral pain ma na g eme nt , qroup Intie r ve nt. Lcn 1,1ith sex offende rs.

sys t e ms theoryand therapy, and strateqies for the deliveryof mental health servicesinruralxewrcundj.a nd,

From June 10, 1991 to Ju n e 15 , 1991, the inter n participated in a training program for imp l ement i ng the parenting programtiQ..Q.Qgy'&Perfect. The train ing involved rec r u i t ment of pe z-t IcLp ants for the program, planning sessions for the program , adult education methods and group problem solvingtechniques.

workingwithStaff

Coal 9: To work with professionals fr om differentfield (l. e.SocialWork and Medicine) in or der to broaden knowledge

andenhance skil ls.

The AdolescentHealth couns elli n g se rvi cedraws uponthe exper-t.Lseof peoplefromvario usprof e s s io nal fieldsinclud ing soc ial work and medic ine. Th e internwas able, duringthe int e r n s hip , to work withpeople fr om both medicineand socia l work .

Dr. Delores Doherty, a pediatrician, ....orked at the Ado l e s c e nt Health Counsell in g ser v ice two af te r n oons a week and participated in all case reviews . In add i t io nto being LnvoLv ed in the intern's case review, Or. Dohe r t y was consulted regardingthreeother ca s e s. Th e s e casesconcerned a youngma n sus pected of havinganattention-deficit, another young man whoexhibited hype r a c ti ve behaviour s and a parent ....nc was unc oo pera tive wLtn the in t e rn regarding her son's tr ea t ment.

Ellen Olive r, a socia l worker, wasconsultedre g a r d i n g seve ralclients . Regardingtwo famil ies,th e interncons u lte d withhe r on a regular basis. The intern was also able to observe Ms.Oliver in threecounsellingsessionswith cl i ent s . Debbie Sue Martin, a psychiatricnurse, was inv a l ua bl e duringthe intern'spresentat i onatcasere vLev. Herin sight s and suggestions helpeda great deal with the case presented . BarbaraKelly, a socialworker, was the Pe er counselling coordinator. Ms.Kelly notonly sharedin f o r mat ion aboutthe program she coor d i nat e d , bu t was of t e n availab le for consultation.

as Ja me s Oldfo rd, the on-s itesupervisor, spent hour s not only supervi singbut guiding , info rm i ng lind chall e ngi ng th e inter n wi th re g ardto case s. Mr. O!df ord' s traini n g was in Socia l Wor le Th e inter nobser vedMr.Old ford in ca un$el ling sess ionson fourccoas Ions.

The int e r nha dampl e expo sure to the fields of soc i al workandmed i c ine and theirapproaches to counsel l ing at th e Adolesc ent Health Co unse ll i ng service . The expe r i e nc e s and knowledg e of the staff added greatly to the le a r n i ng experi en ce of theinternat theAdole sce nt Hea l thcounselling serv ice.

Superv ision

Goal 10 : To videotape (or audiotape) counselling sessions for revi ew by the inte rn, fie l d supe rv i s or, and university supervisor.

Wheneverpossible ,counsell ing sessio ns were videotaped.

Taping eq ui pme nt was not always available . Al s o, not all cli e nt s agreed to tapingofany ki ndandnocli ent s were taped without consent. The intern was, however, able to tape sixteen sessions . The intern rev iewed all tapes. These viewingswere espec ially benefic i al tothe intern who found that viewing the tapes no t only enabled her to gain insight into thepresenting problem, but alsoafforded her a chance to view her own skills and suggestways for Lmpr-cvemant; , Mr.

Oldford, the intern's fi eld supervisor, reviewed wit h her parts ofvi de o t a pe s of counselling sessions.

rs Goal 11: To consu l t we e k ly with the field super v i sor, aa raes Oldford , on pr ogre s s andcases.

The fi e l d supe rvisor, James Ol d t o rd, and the inte rn worked very cl o s e l y tog e ther tor the durat i o n of the in te r n ship. Mr.Ol d f or:d pro videdan orientation and help e d the int ernformali ze her le arninggoals. Hewas consulted on al l cases and share d ma ny of his cases withthe inte r n. The in t ern and Mr. Oldford obs erved one anot her's co u nsellLng ses s i ons and togeth er re viewed parts of se ve r a l of the inte r n's video tapes.

Ea ch we ekofthe in te r nshi p twoho urswere scheduled fo r Mr . Ol d fordandthe intern to meet andconsultoncas e s 0[' discus s theory. In addi tion, muc htime was spe nt ou ts ideof thisbl ock of ti me in inf orma l co nsul tation. Hr .Ol d fo rdwas kept up-t o-dateon eachof the inter n's cases. Aswe l l, the ot he r act ivi t i e s participate d in, suchas visit i ng agenc i e s and train i ng prog r ams, we r e ca r ried out with Hr. Oldfor d ' s knowl e dge and we re di s c ussed withhim.

Goa l 12: Toco n sult we ekl ywiththe intern' sun i vers ity sup erv iso r. Dr. David Watts , on the internship and the intern'spr ogress.

Due to scheduling di f f i c u ltie s and othe r commitm ents, weekly supe rvi si on was not pos sible. Dr. Wa t ts, the superviso r tromMemorial un i v e rsity andthe int e r n consulted onfive occasions. Hr.Old fordwas prese ntat three of these, se s s ions. Dr. Wattsalso observed four family cou nse llinej

20 sessions.

Goal 13:

Educational sessions

To deve l o p and pr ese n t educational ses si ons /packages on relevant ado l es ce nt issues for the purpose of communityand professi onaleducation.

While at th e Adolesce n t Health Counselling Servi cethe intern ha d theopportunityto participateintwopr e sent at i ons which the director ,James Oidiord,made to agenciesonto pic s ofadolescentdevelopment.

OnJune6, 19 91 , thein t e r n ac companiedMr.Oldford toa prese ntation at Adolesce nt Rounds at the Janeway Children's Hospital. The session was onDa t i ngVi o l e nc e among teenagers . On July 25, 19 9 1 , the intern assisted Mr. Oldford in a presentationtoChildProtectionworkers at the Departmen tof Socialservices. Thispresentation/workshopwas on thetop i c of dealing withdifficult adolescen ts.

Summary

An analysisof the thirteen-weekinternshipcompl e tedat the Ado lesce nt HealthCounselling ServicefromMay 6, 1991to August 2, 199 1 was pr e s en t e d . The th irte e n goalsde vised by the internandthe director,Mr.JamesOl dford , werepresented alongwithth e activitieswhichfulfilled the requireme n tsof each goa l. All but two of the thirteengoa lswere achieved.

Invo l ve me nt in the Peer Counse lling program whi ch is affillated with the Adolesce nt He alth counse lli ng se r vicewas re d uc e dtoinf o r ma t i o n gat he ri ng. This wa s duemai n ly tothe

"

fact thatth e Peer Coun s e l li ng pr ogram was notop e r a t i ng out of the same bUild ing as the Adol e scen t Hea lt h Couns e l l i ng Ser vice . In ad d i ti o n , due to sched u li ng diff icul t iesand other commitments, supervisionwith th e Lnt er n- s cntversIw

supervisor was reducedto fiv econsul t a tions whi c h included fo ur direct sup ervi sions of counse lli ng sess io ns . The requirementsfor th e remain i ngelevengoalswere met and, in some cases , surpa ssed .

CHAPTER III RESEARCHCOMPONENT

Introduction

To fulfill the requirements for the internship in the counsellingprogram at MemorialUniversityof Newfoundlandone must undertake a research projectrelevantto the inter nsh i p setting. Th e Adoles cent Health counselling Service specializes inservicestoadolescentsand was interested in providing a group experience for adole s c e nt parents and/or expectant parents. The internhad an interest inthe ne eds of youngpa r e nts and expected toenc o u nt e r ma ny inhe r work. as a schoo l couns e llor. Therefore, the intern, through the Adolescen t Health Counsell ing Service , impl emen ted and eva lua ted the parenti ng program Mobody's Per(g£t, wi t h specific emphasis on the usefulness of th e progra m fo r adolescentparents. This chapterwill present the need and purpose of the study, a lit e r a t u r e review, a descriptio n of the methodology, andthe limitations of the study. Fina lly, the fi nd i ngs anda discussionof the findings re l a t ed toth i s studywill be presen ted.

Need for th eStudy

The ne e dto offer theNohady 'sPerfectpa re nt ing pro gram to a group of adolescents was primarily based upo n four pr e mi s e s . One prem ise was that there was a nee d to get information abou t parenting to yo ung par e nt s . Second l y , Of f e r ing the program to adolesc entpa r e ntswould pr ovide an oppo rtu ni tyto evalua t e the effe ct i venessof the programon

indi vidu alparticipants. This evaluationcould, inturn , lea d to mod i f i c a t i on s of th e progrell'fl which co uld make it suitabl e forimpleme nta tion in schoolsettings. Finally the prog ram wa s to be implemented by a grad ua te stu den t in edu cationa lpsychology as opposedto someonefromthefi eld of medi cine . If th eprogramcouldbe successfUlly imp lem ented by someone outs i d eof th efield ofmedic i ne it couldle a dtomore wid espr ead use of the ~.r.!.§.£.tpr o gra m by tea cher s, couns e llors,andother professionals.

Bar re ttand Ro b i n s o n (1982) intheir study of teen a ge marrie d couple s foun d that both the boys and the girls had unr ealisticexpecta tions of childdevelopmen t and a lackof kncw Le dq e aboutchild re n. Indeed, Sche rman,Korkanes-Rowe and Howard (1990)discoveredthat 40% of thetee na ge paren tsthey sur v ey e d ind i c a t e d a will in g n e s s topart i ci pa te in parenting clas s e s. The r e f ore ,it ap pea r s tha t not onl y do youngpar e n ts needparenting progra msbutth e y also want them. Imp lement ing the Nob o dy's Perf e c t prog ram at th e Ado l e s c ent Health Counsell ing se rv i ce wou l dthe nfulfil an impo rta nt need of you ng parents.

Alth o ughthe Nobody ' s per fect pro gra mhas been offered throughoutthe pro vince of Newf ound land and Lab r a d o r , and at the ti me of writing, th ere was agr o up for ad ol e s c entparents only, inSt . John's, there we r e nopl a ns to form a ll yeva l uat e theprogram ' s impac t on tho se in v o l v ed . Th e r e had ne v er been a fo r ma l eva luat i on of the Nobody' s Per fe c t program when

24 delivered to a group of adolescent parents or soon- to-be pare nts .

Formal evaIuation of theNo bo dy ' s Perfect program could ascerta inits usefulnesswithyoung parents. A determinatio n could be ma d e as to whether or notthe progr amcan increa se such things as self-image and confidence le v e l s. An evaluationcouldshed light on where the program might fall short in its objectives when applied to an adolescent popula t ion. Thiscou l d lead to suggestedimprovementsinthe program with perhapsmodifications to mak.eit more applicabl e forthi s age group.

OncetheNo body ' s Perfect programhas been eva luate d for its use with adolescentparents, suggestions can be made for modificationsto th e program. Thesemo d i fi cat i o ns couldbe aimedat maki ng th eNobodyl s~pr og ra m sui t ablefor use in schools.

The successful imp lementa tio n of the Nobod y '§ perfect pr og r a mby a graduate studentineducationpsycho log ywould be adevia t ion fr o mthe usua l me a ns of implementing the pr ogra m.

To date, the pro gram has only been altered by publi c Health Nurs e s. The Newfou nd la ndDepartme ntof Health was in favour of havi ng persons from outside the medi c al pr o fes s ion implemen t the Nobo dy 1s Perfe ct prog ram (L. Vivia n - Bo ok , pers o nal commun icat ion, May, 19 9 0 ). It was fel t that mor e wi d esp re a d use of the prog r am wou l d result if peo ple other thanmedica l personnel could offer it.

2S In conclusion, there is a nee d to off e r the~

~ program to a gro up of adole sc e nts who meet the cr i t e r i a for four re a sons. Onereason isthene e dto impa r t valuable information about parent ing to this population.

Se c o nd , there is a ne e d to evaluatethe program to determine it s effectivenessforthis population. Thir d, evaluat ionof the program can le a d tomod ifica t i ons to makethe programmore effective and make it suitable for imp lem en tation in school settings . Finally, successful implementation by someone outsideaf the field of medic inecouldenablethe prog ramto be more widely used.

Purpose oftheStudy

The purpose of the study was to determine the effectivenessof a short-termparentingprogramfor adolescen t pa r e nt s , or soon-to-be parents. The proqram was close ly evaluated inanef f or t tofind out what aspects of theprogram were effective or not effect ive with that age group.

Recommendationswouldbe made as to ho ... toimprove the pr'cqr'am When it is used ...ith an ado lescent population . Th i s may succeedin making thepr og r a m a suitableone for use in hig h schools throughoutthe pr-ov Lnceand thus reacha largernumber of people who need the servic e.

In addition tousing the same methodsof evaluation us ed bythe original developers of Nobody'g Perfect, there was a more thorou g h assessment of each participant's self-image usingthe Of fer Self - Image Questionnaire for Ado lescents

'6

(Of fe r, oat r ov and Howard , 198 2) .

Thegoa l s of thisprogramweretoeffect posi ti ve chang e in parti ci pants 'kr.owl e dqe .attitude andbeha viour inre l a tion tothei r childre n ' s he al t h , safetyand behav iour, and to inc rease pa r tic i pa nt s' self-i llage as parents. The st ud y wou ld determinethe effec tsof a sho r t -te rm pare nti ng program for ado lescent s on the part ici pa nts' knowledge, at t i t ude s , and beha viour in rela t i o n to the i r chi l dren's heal th,safety and behaviour; andonpa rt i c i pants ' se lf -image.

Review of tileLi t e r a tu r e Introduc tio n

The research component of this int e rns h ipinvo lvedthe imp l eme nt ationand evaluationof a paren ting program. While the programbeing used was not specifically designed for ado l e s c e nt parents it had features which made it an app r o pria t e one foruse withthis particularpopulation .(see pages 46-48. )

The reviewof the lit e ra tureshows thatgroupsarebot h aneffectiveand an efficient means of deliveri ngse rvices to adole s c e n t s (Gazda, 1989). The effects of adole sce nt parenthoodare varie dand wide-re aCh i ng ,aff ectingthe Child, thepare ntsand the pa r ents' fami lies.Fortheparent withfew par en ti ng skil ls the r e can be consequences fo r the chi l d (Glossop , 1983) . pare nt i ng programs foradolescent pa rente can go a longwa y towards allev i ating some of the problems

27 parents face , andpre ven tin g po te ntialproble ms fr omarisin g (Ferguso n, 19 87) . Th i s revi e wof the literature pre sont;aa rationale forthe use of grou ps with adolesc ents, discusses th e effects of adolesc e nt pare n t ing on tho se involved, rationalizesparentingprograms for ado lescent sandpresents Nobody'sPerfectas a program foruse withadolescentparents.

In addition, the Offerself-ImageQuestionnaireis described and presented as a su itable ins t r ument formeasu r ing the self- ima g e of ado lescents who have participated in a parenting program.

Groups forAdo l es c ents

Groups can be an effi ci ent and an effe ct ive means of delivering services to a gr ou p of adol e sce nt s . The developmental levelof adolescentsmeans theypossesscertain characteris tics...hLc h make them par t.Lcu LarLyqccdcandidates for qroup interaction . The therapeutic experience of the qrcupis one tha t allo...s adolescents to gain muchfromthe experienceandmakes the groupa safeplacetoshare and q rc...

The qrcu ps' composition, too, can be importantindetermining itssuccess or failure (ce ed e , 1989).

Gazda (1989) co nt e nde d thatLa nquaqe or ver-ba Li z Lnq is the most na t ura l and efficient communication medium for adolescent age groups and theref ore advocates qroup counsell ing for addressing the needs cfthe s e groups.Ga zd a (19 89) conte nded that adolescents are capable of making

2B

decisions in an effective manner. Brooks (1984) lis te d seve ral cnaracecr IstLcs of ad ol escents that se e mingly make themgood candidatesfor group interactio n. These include th e ability to respond reciprocally in interperso nal relation ships; understanding and acting in ac co r dance ....it h sit ua tio nall yappropriate socialcustoms; being open to the opi n i o ns andactionsofothers;coping success fullywith peer pres sur ej unde rsta nding to some degree the problems and difficulties of others; respondingto the feelings of ot h e rs and being able to express oneIs own feelings; developing support from pe e r relationships; and appreciating one's similaritiesto others.

There are many ben e f i t s of partici pa t i ng in a group expe rienceforthose whoare invol ved. Yalom (19 85) descri b ed eleven prima ry factors tha t make up thethera peu ticexperi e nc e ofgrou ps whichcanle nd grea t support tothe idea ofa gr ou p appr-o a c h for vir t ua l ly any age level , and certainl y for adolesce nt s and young adu l ts. Groups, ac cord i ng to Yal o m, of fe ranopportuni t yfor me mbers to observetheimprovementof othersinthegroup for insp irat i o n that the y too canimprove . Ifthe le ad e rhas expe riencedwhat thegroup membersare going throughitiseven bet terbecause the membe rsdev e lopa stro ng conv ictio ntha t the ycan bestbe under s toodbysome o ne whohas

"been there and bac k". Yalomcontended that once group membe rsfind out theyare no t alone ,they real i zethey ar e not so uni que. They se e. tha t there are othe rs faci ng si milar

29 situations. Thiscr e a t e s a pcwer fu Isource of relief and can go along way towards he lp i ngthe m deal wi t htae Lr situation . In c luded as well in the therape uti c expe ri e nc e is the conceptofalt r u ism when members help one anotherand this,as a result not on l y boosts thei r own self-esteem , bu t for a While enables them to forgetthe irown problems (Yalom ,1985).

Yalom (1 9 8 5 ) fe l t that peopl e developsocialsk.illsin groups; skills that may not be ach iev ed in an ind iv i d u al setting . Pe opl e ingro ups learntobehe l pful ly responsi veto ot h e r s ; theyacquire methodsof con f lictreso lution; they are less likelytobejudg e men t aland more likely tobeca pa ble of empathy.

Imitative behaviour, whereby group members may model the ms e l v e s after the therapi st or ot he r group members, was ef cc discussed by YaLom(l 98 5 ). Thegroup setting is a good arena to "tryon "new behaviour sand discard thosethat do not fit. The members are ableto find out what they are, in the proces sof findi ngout what they are not. Group members also Lea rn new behaviours through self-observation and feed back fr o m othermembers; behavi ourswhic h ca n be ca r ri e d over to the person'ssocialenvironment.

'ialom(198 5 ) contended thati fgroupscan achieveale vel of group cohesiveness akin tothe relationshipstrived for in individualco un s el li ng ,then signi ficantchanges can occ ur in the group. Sel f -es t e em ca n be fostered, self-disclosu r es occu r, risk.- tak ing ta ke s place and there is const ru ct ive

)0 expression of conflict.

Existential factors come into group counsell ing whereb y th epe o p l e in th e groupare able to face life inits reality, see whatthey mustha n d l e in lifeand take responsi b i l i tyfor themselves Yal o rn(1 9 8 5 ) . Schinkeand Gilchrist (198 4 ) fo und th atth emajority of adolescent boys who took pa rtin gro up s designe d to providelife skills counsellingreported that th e y enjoyed the counse l l i ngproc ess. Inadditio n the st u d y found qroup counsellingto bemo reef f e c t i v e at increasi ngso c ie ta. l adapt a t ionamong these adolesc entsthan inf o r mat i o n sess ions or no counselli ngat all.

Groups for ado lesce nts can be compos ad insu ch away as to allow for maximumbe nefit for t.hc se invo lve d. Eight membe rs iscon sideredtobe an optimalnumbe r. Ho....ever, group leaders mayfind they have to sc r eentwentytothirtypeople to get fiftee n. The n one must allow for absentees and prob ab lyexpec tsix toei ght regula r s , thr ee or fourwhoshow up occasiona lly, and three who are abse nt mor e than present (Kra ft, 1971 ) . Kraf t (1971) supporte d 45 to 90 minute sessions, butsuspec ted that ado lescents fi ft e en end ove r will oft e next e ndthe i r sess ionsinfo rma llybychatti ng beforethe meeti ngor getting tog ethe r immedia tely after.

Insummary, groupsforadoles c e ntscanbe an effective me a ns of deliveri ngser v icesorimpa r t in gskil l s. Ado l e s c e nt s are at the age whe re ta lk ing is their preferred mode of communi c a tio n (Gaz da , 198 9 ). The the r a p e utic experienceof

31 groupinte r a c t i o n can do a lot toenha ncedi s c los u r e , improve soc ial skills, change behaviours and increaseself-esteem (Yalorn, 1985 ). The groupcan beeasi l ycomposedtoes t a bli sh a safe env ironment for growthto occur (Kra f t , 1971) .

Molasce n t paren tsand th eir CbiU;l.I:..!m The fa ctth a t thereare teenagers who are par e nt s will co rne as no shock to anyone. More t eencqe r-a are sexually act ive today than twenty or th ir ty ye a r s ago and more ar e getting pregnant (Ricke l, 1989). Glossop (1983) ind ica ted thatmo r e than80%ofte e n a g e mothers are remaini ng unmarried and keeping th e i r babies. He felt that we are in the midstof a "t e e na g e baby-keeping epi demi c" (p.Jl) . Th i s trend must naturally lea d us to reflect on the supports adole sc ent parents require.

Glossop (1 98 3 ) repor ted that in Cana da one in five te e na ge girlswil l become pregnantbefor eleav i ng hi g h school;

that therear e 50,000 ado lescent pregnancies incene de each year;that one gi rl intwe nt y between the agesof twel veand nineteen will become pregnant each ye a r ; that 40% of all teenagegirls wil l become pregnant before they are twentyand tha t nine percent of tine babies born in Canada are born to teenagers. For Newfoundland and Labrador, the pr-cvincLaI Depa r tment of Health re po r t e d 925 live births to women nin e t e en and underin 198 9 with twelveof those mothersbeing under fifteen year s of age (8 . Kavanag h, personal communication, February, 1990). This represents twelve

32 percent of the births in the province.

Adolescentpregnancy poses a real and significant thr e a t to the life chances, opportunities and expectations of the adolescentgir l andher child. Mo r t a lit y ratesarchig h er for mot he rs aged fif t een to ninet e e n th a n they are for older For girls unde r fourteen the mort.ali t y rate is gene r a lly twi c e tha t of mothe rs ov e rtwent y (Glos so p , 1983 ).

The infan tsof teenagemothe rsarealso morelike lytobe born prema ture , and to be of law birthweigh t (Glosso p, 19 83; Me nke n, 19 8 1 ; Washi ngton&Glimps 1983). Glassop(1983) also suggested that theinfa ntsof teenagemoth e r sare at a higher ri s k of beingabu s ed andneg lected. Fre q uent l y themotherIs educatio nal oppor tu nities and.chancesfor stab l e emp l oyme nt are lesse ned and de pende ncy on welf are mayresul t. (Card &

Wi se , 1978; Glossop, 1983; Menke n , 1981; Moo r e, Ho f ferth, We rthermer, Wa ite & Caldwell, 198 1; washi ngto n & Glimps, 198 3 ). sc ot t-Jon e s & Turne y (1990) stud ied the impact of having become pr egnant during adole scenc e on educational atta inment and inc o me for bl ac kadult women . Thewome nwere gr ou ped int o th r ee age gro u ps compr i sed of age s 20 to 24 years ; 25 to 34ye ars and 35to44ye ars. For eac h group , it was found that adolesc en t pr e gnancy depr- ea eed educational attain mentand inc ome inthe ea rl yand mid dle adul t years.

Wr i t e r s ha ve rep o rt ed on st l..i.1ies tha t looked at the effe cts of ado lescentparen thoodonthepa r e nt ing practicesof the you ng women . Grow(197 9) found tha t seventeen ye a r old

J3 mot he r s of eighteen month ol d ba bi e s fo u n d ch il d care difficultthan older mothers. Fli c k (1980) reported that mothers younger tha n twenty in low income popu lations exhibited le s s interact ionwith their ch ild r e n andse e me d less accepting and in v o l v e d th a n older mothers. A study by Baranowski, Schilmoel le r an d Higgins (19 90) fou n d th a t a comparisonatthepa r ent i ng attitudes of ado lescentand older mothersrevealedthat adolescentmothersscored significantly lower tha n did ol d e r mothers in display ing empathy towards chil d r e nISneeds. Lawrence(1 9 BJ) felt that motherswhomade plans fo r the pregnancyand the inf a nt and who s e family was sup port i ve were doing bette r in termsof ma t e r na l attachments after six weeks. Lawr e nc e conclude d that int e rve ntion programs could impr o ve infant outco me developmentally and psychologicallyand sho uld, therefore,be developed.

Sahl er (198 3 )exploredthe factors that seemtoinf l uen c e successinmothe ri ng. Among ot he r things she contended that young mothers need adequa tek ncvl edqe of chi ldbehaviour and development. These mothersalso needcon f i de nc e in their own per s o nal abilit ies, a quality that is often lacking in adolescen tsand certainlyunderdeveloped in most.

Alle n (1980) advocated prenatal care for young parents- to-be, contending that this would impr o ve the chances of a heal t hybaby and better prepare the teenagers to beparent s. Among other things he said that teenswantinf o r ma t i onabout ho w to care for children, and factual informa tio n and

J4 cou nselli ng in preparationfor par enthoo d.

TheAdo1 asc entfather

In discussions about te enage pregnancy the "oth er"

pe rson, the father, is often forgotten. There has been a

"mother-centredbias"in our culturewithli t t lewo r k doneon the conce rns of the father in the caseof teenagepregnan c y (0 50f5 k y and cecrskv, 19 83 ) . Menken (19 81) reporteda stud y that found 63\ of teenage fathers weremaintainingrelations with theirchildrenfi ve years after thebaby'sbirth.Of this 63\,onethi r dlived W'lth th e i r Children, one-t h i r d saw thei r children oncea week, andone-thirdvisitedtheirch ildre n on a r-equLar-basis. Cervera(199 1 ) discoveredtha t somepregna nt teens reportedthatthey communicatedwiththei rbaby 'sfather onmore than a weekly basis. However, being invo l ve dwith theirchildrendoesnot mean they are comfortablewithchHd- re a r ing. Barrett and Robinson (198 2) reported a stUdy of teenage married couples wh i ch saw boththe boys andgirls111- preparedfor parenthood. They had unrealistic expectationsof ch ild development, a lack of kno wl e dge and experience concern i ng ch ildren, wereoften imp a t i ent and intole ran t of childr e n and tended towards physical abuse in the i r chfId- re a ring practices. Elste rand Lamb (1986)reportedfrom their study that some or the young fathers they interviewed neede d and wa n t e d hel p adjusti ng to the stresses of pre g nan cy and prospective pa r e nt hood. However, Cervera (1991) suggest e d thatsome teenage girls may havehad to choosebetwe e n their

35 par ents' or the baby15 father'5 support. Cerve ra 's study reporte d th at there was minimal communication betw ee n the pare ntsof 15 pregna nt teens and the fat her sof theirbabie s . Cerve raconc ludedthatfamily attitudesto wa r d s the fath e r sof theirpregna ntte en' s baby af f e c t the ir communic ation with and clos e n e sstothe fat h e r . Theautho rsugg ests fur t h er reseerc n into the relatio ns hi pbetweenth e family of the preg na nt tee n and the fa the r of the pregnant teen's ba by . Barre t.t and Robi nson (1982 )re c omme nde d tha t fur t he r rese arc hwas needed and that society shoul d not assume that adolescen t ma l e pa ren ts arenotintereste d inpare nt i ng. Age nc i e s shouldpl a n programs inpa r enting that invo lve both young me n and yo ung

In summary, wi t h an inc r e a si ng number of te e na ge d par ents hav i ng and the nrearing the ir children the re is mo re reasonto beaware of thedange r s tha t are inheren t in te enage pregnanc yan d the issue s that arise when a teena ge r becomes a parent (Glosso p , 198J). This section atte mpted to sho w that th e r e areda nge rsandpr o bl e ms conn ected wi t h being ate e na g e parent, both for the pa ren t(s) (Menken , 1981) and for the child (Ba ldwi n " cain , 1981). When di s cu s s ing adolescent pregn an c y one must al s o beawa r eof the ne ed s of the father Who is of t e n time s an adol esc e nt hims elf (OsofskY "

Oso f s ky,19 83).

36 Parent in g Pr o gr ams forA.do lescents

Many prog rams for adolescent mothers foc us on pre natal ca re and areai me d atke e p in g the girl in school,or getting her to goback to school. Some are aimedat preparingthese young women to beparentsanda few aimtoprepareyoung men tobefathers. This secti ondi s cussessome ofthe reasons'Why ne w mothersneed training in orderto be effect iveparent s and points out thepr o b le ms of be ing an adolescentat the same time as being Il parent. In this sec t i on there is also a descripti on of a numbe r of paren ting pro g ram s. Someprograms inc l ud e dfat h e r s ;so me did no t. somehavehad more extensive evaluationprocedures tha n others. Allseeme d to acknowledge theimpo rta nc e of equipp ingadolescentparentswith skillsto make them more effective parents and the need for compre he n s i ve progr a ms.

Adolescents themselves seem to want programs aimed at preparing them better to be parents . Scherman, Korkanes-Ro....e and Ho....ard(1990) surveyed fifty-seventeenage mot hersinan er ror-t to exa mi ne the i r needs as expressed by these young mothers. Theydiscoveredth a tpa r e nt i n g classes ranked third among teenage pa r e nt s' perceived needs , along wit h medica l atten tion, play groups forch i l d r e n and transportation. Jus t over forty percent of those surve yed expresseda desire to par t i c i pat e in some kind ofpa r e n ting cl a s s . only8.8\ had ever participatedinsuch a program.

Burtand Sonestein (1985) collecteddataon t....enty-one

J7 fed eral lyfunded careprogra msin theUn itedStatesin 19 8 2. Theyfoundthat ee ee programsconc entrated theirenergieson providingserv i c e sduringpregnancy andimllle d ia t e l yther e a ft e r butdid not focu son cli entneedsdur i nqthe parentingperiod.

Theauthorsfelt thatsix ecnt.ns after birththe mothe r ne e d s to knowhow tomanage theirbabies,not tome nt i onhow tode a l with th e conflicting role s th e y face - mot h er, stude n t, tee na ger , and possiblyworker. They concludedtha t teenag er s needhe l p cop ing with actual mothe ringand that service smust be createdto help young mothers throu g h thead j ustments they have to make.

Ca t ro neandSad ler(1984) sugges tedthatpare nteduc a tio n prog ra ms for adolescentsmust be re s pc nstve to the various soci a l. ps ychol ogical and cog n i ti ve aspect.s of adolescent parent.hood . They designedandimp l eme nt.ed a paren t.educa t ion curricul um for a high school se t.to.lng conside ring the developmenta l ne eds of the adolescent. Ac c o r d i ngto Cat rone andsadle r(1 9 8 4 1 adolescentpreg nancyis a timeofpote ntia l str ess aste en a gepare nt s fi ndthems e lve s facing not only the develo pmenta l crise s of adolesce nce, but alsothe demands of ea rly parenthood . Bothof the s e periodsmean qrc....th,chang e and potential cont'l lct , but occurr ing together , need s and problemsfrom onemay conflict withne e ds and prob lemsof the other. They su mma r i zed fi ve major area s of co nf li ct:

Ado l e s c entegocentrist i c though t and narci ss ism con fli c t withthe pare nt'sneed toforlll anempa thet icandmutualisti c relat i on shipwiththeinfa nt. The

aa adoles c en t ,on the verge ofide nt i ty

fo r mati o nneeds toexpe rimen t wi th ro lesandpeers. Howev er, parenthood dictatescertainro lesand tasks that are hardl y fle x i b l e. The ad olescent girl whois jus t becomingcomfortablewith a changing and ma t u ri ng body is then confronted with the bodily changesand transformationstha t occurdur ing pregnancy, deli ve r yand thepostpartum period. At a timewh en the adolescentis desperate lytry ingto emancipatefrom parents and family,thede ma nd s of caring for cners own childcontribute to a prolongedand forc e ddep e nd e nc e on family. Finall y, the teenagerwho is jus t lear ni ng tothink: in abstract andfut ur e terms , is faced

with thedaily needtosolveproblems and planfor the futureconcerning child-rearing is s ue s andduties.

(p.63)

Catrone and Sadler (1984) concluded that tihe developmentally vul ne ra bl eee e ae ece nepa r e ntis inneed of and ope n toprogramsof supportiveand educational out r e a c h. The programthat Catrone and Sadlerdeveloped included parenti ng prac tices, as wellas an emphasison self and a component on ch ilddevelopment. Te a Chi ngstrategiesinc l ud e d role-playing;

biographical scripts, where students responded to wri t te n vignettes; family diagrams, which graphica11y illustra ted social and psychological aspectsof fa mil y development; and child development charts wh ich emphas ized five areas of development- physicalgrowth,inte l lectualgrowt h ,emotiona l grow th, play and safety. Unfortunately,the creatorsofthi s progr amoffered no evidence of its effectiveness. Ho wever , it provid e s usefu Linformat ionforcr e a t ors and implementorsof other programs.

A survey from 1981 reported by Vinovskis (1988) shows that fivepr ogr a ms for adolescent parents ....ere cost effective and deaonsnreced their ability to improve the li ve s of te e n ag ed parents. The author also described "Pr o j e c t Red irection" whi c h was undertaken in four American cities.

The s e programs included sessions on parenting. All four programs reported success in getti ng the parents back to schoo l. No investigation was conducted withre ga r d to the success of the paren ting component of the programs. No fatherswere included in these programs.

Delatte, Orgeron and Preis (1985) conduct ed interven tio nprogram for seventy- fiveadolescent parentsand expectant par en ts within a schoo l system. The prograll was conductedover a three year period and included educatio nal and counselling aspects as well as material on parenti ng.

Thi s program was no t available for the fathers. Three types of data were colle c ted - knowledge of child de ve lopment , ques t ionna iresto measurestudent satisfactionwith the cour se activities , and inf or ma t i on on dropouts. Inthe threeyea rs the pr o j e ct was run , in knowledge of child developme nt as measu r edby objective te s t s , the treatment group consist e nt ly sc oredsignifi c an tly hi g he r tha n the control gro up. Ei g ht y perce nt of pa r t icipa nts re s po nd e d posi tively to act i v it ie s and there was a si g nif i c a ntl y lowerdropoutrate for parti ci pants.

One example of a prog ram th a t not only addres s e d

'0 parenti ng is s u es but als o included adolesce nt fathers descri b ed by Palmer (lg S l). Palmer repo rt ed on ill program condu c ted in Detroit that included indiv id ua l. conj o i nt, familyand gr oupcounselling. It as s iste d client s toremain in school and incl uded parenti ng skills sessions at two levels. Level I covered pregnancy and th e child!s fi r s t twelvemo nths . Level II coveredtwelve mo nths to three years an demphas hedsocia land emotional de ve lopment. Everything from nutritionto safety to toilet trainingwas covered and thefatherswer-e encouragedto participate. Weekly individua l and group asses sments as well as pre and post sessiontes ts re p orte d lyshowed favourable re sult s . The author felt that the service was a vi t a l one whi ch met the needs of the ado lescentpa r e nt.

Fergus on (1987 ) descri bed GRADS (Gra d ua tio n , Realityand Dua l Ro l eSkil lsl,anin-s ch oo l pr ogram tor pregnant students and/oryoungpare nt s. Th ema in goal was toke e p studentsin sc hool untilgraduati onbutit also includeda componenton ch ild deve l opmentand parenting skil ls.The programoffered servi c e s to fathers as well. Eval u a t ion of the progra m reporteda reductionin the drop ou t rate for parti cipants.

In 1984 -85 only 12\ dro pped out as compared to the United statesnatio na l dropout ra t eof 80\fo r pre gna nt teens. There was no eva lua t ionof the componen t devoted toparentinqand child development.

FUl ton, Murphy and An d e r s o n (199 1 1 explore d whethe r or

not an interv e n tio nprogramfor adolescent mothe rs wouldbe effective inincreasi ng the mothers' knowl e d geabout child gr owt h and devel opment. The author sbelie vedthat inc r eased knowl edge wou l d resu lt in decreased tendenci e s towa r ds inappropriate interact i ons with children, that is , child abus e. The Ado lesc ent Paren ti ng Program they st udi e d was largely an education a l program desi g ned to determ i ne, in con SUltati on ,with th emother, hernee ds . Th emot her wasthen direc ted towar dsres ources and services tha t wou ld me e t her need s. The prog ram was found to be effective in yield in g signif i cant ga i n sin knowl e dge of infantdevelopme nt by the you ng mothe rs. They al s o showed lowe r sc o re s onThe child AbusePot en t i al Inve ntory following comple tion ofthe pro gram.

This led the authors to conclud e that as kno wled g e of child dev el opme n t inc re as e s, the possibi l ity of ch ild abus e de c r e ases. The y al so fel t that short-term inte rv enti o ns to ena b l e yo u ng parents to ga in skills and knowledge and to pr a ct i c e pos itiveparen t i ng practices can be effect iv e.

Lewis (198 9) st u died the effect iveness of two parent educat i onprogramson the parenti ng at t i tude s andself -i mage of adol esc en t mothe rs . She con c l ud e d tha t a sho r t - t erm intensive par ent in g progra m may be more ef f ec t i ve than a longer-termprogramin that the more inte ns e model provides mor e opportunity for immediat e fo llow-upand mon i to r ing as wellas theimme d i ate rein f orcement of thecon cepts presented.

Jordo n (19 8 9) stUdied a parent edu catio nprogram Which

42

was designe d(or rural, whiteadolescent pare n t s. Th e st udy expLor-ed whethe r rural teen pare nts' knowledge of chi ld deve lopmen t cou ld be incr ea sed by thei r pa rt i cipat ionin a parenteducationpr ogra m andifthe i r self -estee mand senseof masterycou l d be incr e a sedby such parti c i pation. Jordon's find i ng ssh owed a signi fican t inc re asein knowledge of child de vel op men t by parti c ipa nt s . She reported the la ck of a sta t istica l lysi gnifican tch a n ge in sel f- es teeman dII.senseof maste ry for anyof the mothersand explai nedit byasse r t i ng tha t eit he r the cons t ruct of self-est e em should not be expected to cha ng e ove r ten wee ks , or that th e mea sur e me nt inst r ument use d wasno t appropriatefor program eva luation .

Evangelisti (198 9 ) st u die d the efficacy of three inte r ve ntio n strategiesconductedwithmothers of infants ....ho were approximately six mon t hs of age. In two of the int e rve nt i o ngrou p s themot hers metoncea ....eekfor five weeks wi t haparenttr a i n in g instruc tor. Procedu resfordeve IcpLnq ef fect iveparent ingskill s we r e dis c us sed. One of these t ....o groups also received 15 minut e sof be ha v i o ur trainingwhere they practisedwhat they had learned in thedi s cu ssiongroup through teac hing their inf a n t s. The th ird group was an information-control group which was given a booklet which contained all of the inf o rm a t i o n covered in the group discussions. A paper and pencil te stwas us e d to measure parentingskills. Analys is of results of the tests indicated that the groups ....ho ha d met and discussed the topic of