Basic principles of adolescent prevention and intervention

1. The Young Parenthood Program: Co-Parenting Counseling with Pregnant Teens and their PartnersPaul Florsheim and Megan HowardUniversity of Wisconsin MilwaukeeJason Burrow SanchezUniversity of Utah

2. Provide services through schools, health clinics, juvenile justice Create protective relationships to ameliorate risk and build resilience Make message directly relevant to adolescents Focus on building strengths Basic principles of adolescent prevention and intervention

3. The Young Parenthood Projects • Prediction Research: YPS (Salt Lake City & Chicago • Prevention Intervention: • SLYPS(Salt Lake City) • MYPS (Milwaukee)

4. Many Collaborators: David Moore, Trina Seefeldt, Le Ngu, Laura McArthur, Sarah Heavin, Rocio Parades, Jasmine Sanchez, Cristina Hudak Claire McCann, Sheri Johnson Katie McElligott, Megan Howard, Trina Salm Ward, Amy Kirby & Many Others Hundreds of Participants, who shared their time and stories Funding agencies: Office of Adolescent Pregnancy Programs NIMH Robert Wood Johnson Foundation University of Utah University of Wisconsin Milwaukee Thanks to….

5. Part I: Theory and Developmental Research

6. Hypothesized links in Interpersonal Development Couples’ relationship (a) Dating (b) During Pregnancy (c) Across transition to parenthood Adolescent risk and protective factors related to interpersonal development Quality of Parenting and Co-parenting Child Functioning

7. Why include fathers? Young couples are at risk for conflict-ridden unstable relationships, contributing to negative parenting outcomes.

8. Interpersonal hostility (observed), substance abuse, conduct disorder and predicted couple violence among Chicago couples.

9. Quality of relationship with parents and partner at prenatal assessment predicted Child Abuse Potential when child is two.

10. The link between fathers’ risk for paternal dysfunction is mediated by his interpersonal functioning, which is mediated by his partners’ interpersonal functioning (Ngu & Florsheim, 2011)

11. Take home message: Target relationship skills specific to co-parenting • Increase interpersonal warmth • Decrease hostility, especially aggression • Develop family support system • Treat conduct disorder and substance abuse as a relationship problem

12. Part II: A Preventive Intervention Model to Support Co-Parenting

13. Preventive intervention to facilitate interpersonal development Adolescent risk and protective factors related to interpersonal development Couples’ relationship (a) Dating (b) During Pregnancy (c) Across transition to parenthood Quality of Parenting and Co-parenting Child Functioning Co-parenting Counseling Interpersonal Theory Attachment Theory Family Systems Theory

14. THE YOUNG PARENTHOOD PROGRAM 1. Introduction & Engagement 2. Identify Strengths & Goals 3.Interpersonal Skill Development 4. Role Transitions 5. Summary and Preparation 6. Parenting Support and Booster Sessions

15. YPP CounselingPhase 1: Engagement • Introduce goals and philosophy of program • Solicits the couple’s “story” • Acknowledges any cultural/social issues relevant to the particular couple • Engages family system if appropriate

16. YPP CounselingPhase 2: Setting Program Goals Assist couple in identifying: • personal strengths and “areas for growth” • relationship strengths and “areas for growth” • personal and relationship goals

17. YPP CounselingPhase 3: Interpersonal Skill Building • Couple specific interpersonal and communication skills are addressed: • Reflective Listening Skills • Problem Solving/Coping Skills • Support Skills • Expressing Needs and Feelings • Acceptance of Other and Self - • Conflict De-escalation • Family Planning Communication - • Minimizing Negativity

18. YPP CounselingPhase 4: Role Transitions • Examines changes in roles and relationships that accompany the shift to parenthood: • Within each co-parent’s family • Within the co-parents’ relationship • Within each co-parent’s social relationships • The couple learns how to ask for support from others • Family/support people may be invited to a session

19. YPP CounselingPhase 5: Summing Up and Looking Forward • This phase provides an opportunity for the couple and counselor to recognize and acknowledge the gains made by the couple through the YPP • Address anticipated parenting issues

20. YPP CounselingPhase 6: Follow-Up Co-Parenting Support • Counselor meets with the couple 2-3 times after the birth of the baby for co-parenting “booster ”sessions • Support positive adjustment to co-parenting • Reinforce previously learned skills • Address new issues and needs, as appropriate • Focus on parenting issues as necessary • Prepare couple for the close of YPP

21. Example Skill: Reflective Listening Steps : • Ask partner to express feelings or point of view regarding a recent disagreement • Bite tongue: allow partner to speak without interruption • Repeat back what was heard • Partner clarifies difference between the message sent and the message received

22. Demonstration of Couples-Based Intervention

23. Demonstration of Couples-Based Intervention

24. YPP Care Coordination • In addition to YPP Counseling, each individual within the couple receives Care Coordination (case management) services: - Basic Needs - Health Care - Education - Financial Management - Employment - Parenting Skills - Housing - Child Care - Legal Issues

25. Participants in the Preventive-Intervention Study • Pregnant adolescents (primaparous) and their biological partners • Less than 26 weeks gestation • Recruitment through public health clinics and schools • Retention rate: @ 80% • Ethnicity: • 30% Anglo • 60% Latino/Latina (about half Spanish speaking) • Age of Pregnant Teens: 16.5 • Age of Expectant Fathers: 18.7

26. Young Parenthood Program: Assessment Strategy Time 1: Pre-Intervention Emotional and Behavioral Problems Response to Stress Questionnaire (Conner-Smith et al. 2001) Self Reported Attachment (Brennan et al. 1998) Quality of Relations Inventory: Partner & Families (Pierce, 1996) Observed Interpersonal Behavior with Partner (SASB- Coded) Semi Structured Interview Time 2: 8-12 weeks post birth Same measures administered at Time One Time 3: 18 Months Parenting Measures Observed Parent-Child Interaction Self Report Parenting Behavior Partner Report Parenting Behavior Child Abuse Potential Inventory Parent Report of Child functioning Random Assignment and Intervention

27. Change in Intimate Partner Violence Scores by Treatment Group at 12 week follow-up

28. Fathers in the Young Parenthood Program more likely to remain positively engaged in co-parenting and parenting

29. Many adolescent couples are willing to accept couples counseling from a skillful, supportive therapist Program has stronger effects on fathers than mothers Relationship deficits observed among pregnant adolescents and their partners are a potent risk factor and an opportunity for intervention/growth Lessons Learned

30. Part III: Evidence Based Model and the Problem of Flexibility: Is There Room for Adaptation?

31. From prediction research to clinical research Prediction-Developmental Research Identification of developmental trends and exceptions to the trends Intervention Hypotheses Program Development & Implementation Social Contextual Change Clinical Supervision and Data Analysis

32. Program Development and Adaptation • YPP was not designed as a ‘cookbook’ • Adaptation needs to acknowledge context and culture as mediating factors in YPP effectiveness • Modeled after work of Guillermo Bernal • Need to be aware of bidirectional influence and how culture is imbedded within these ‘levels’ Social/Environmental Family Individual Socio-ecological model

33. Adaptation Process • Revisions and refinements of YPP • Flexibility in implementation exists within a set framework • Milwaukee adaptation solicited input from experts and potential consumers (young mothers/fathers) • Concept of cultural humility (Tervalon & Murray-Garcia, 1998) • Being open to learning and appreciating the cultural beliefs, values, and practices of another person • Engage in self-reflection, self-evaluation, being humble • Critical piece in developing rapport with participants, maximizing the potential benefit of intervention

34. Achieving a balance: flexibility while developing an ‘evidence-based program’ • ‘Evidence-based’ as a process, not a product • Importance of on-going training and clinical supervision • Staying true to the principles of the intervention even though implementation will vary • Keep culture front and center • Acknowledge the influence and importance of culture while realizing that one’s cultural values and beliefs will impact implementation and effectiveness

35. THE END Follow up father-child interaction