Social Work Practice with Adolescents

1. Social Work Practice with Adolescents

2. Outline • What is adolescence? • Adolescent Physical Development • Review of select theories that discuss adolescence • Two common problems you may encounter in work with adolescents • NASW Standards the Practice of Social Work with Adolescents

3. What is adolescence? Adolescence (lat adolescere, (to grow) is a transitional stage of physical and mental human development that occurs between childhood and adulthood. This transition involves biological (i.e. pubertal), social, and psychological changes, though the biological or physiological ones are the easiest to measure objectively. Historically, puberty has been heavily associated with teenagers and the onset of adolescent development. In recent years, however, the start of puberty has had somewhat of an increase in preadolescence (particularly females), and adolescence has had an occasional extension beyond the teenage years (typically males). This has made adolescence less simple to discern.

4. What is adolescence? The teenage years are from ages 13 to 19. However, the end of adolescence and the beginning of adulthood varies by country and by function, and furthermore even within a single nation-state or culture there can be different ages at which an individual is considered to be (chronologically and legally) mature enough to be entrusted by society with certain tasks. Such milestones include, but are not limited to, driving a vehicle, having legal sexual relations, serving in the armed forces or on a jury, purchasing and drinking alcohol, voting, entering into contracts, completing certain levels of education, and marrying. Adolescence is usually accompanied by an increased independence allowed by the parents or legal guardians and less supervision, contrary to the preadolescence stage.

5. Adolescent Physical Development • Early physical maturation has a number of benefits including better adjustment, greater popularity with peers, and superior athletic ability. • In contrast, late-maturing boys are more “childish,” exhibit more attention-seeking behaviors, and have less confidence (Crockett and Petersen, 1987)

6. Adolescent Physical Development • For girls, early physical maturation is more likely to have negative consequences, especially during the early adolescent years • Early maturing girls tend to have a poor self-concept, to be dissatisfied with their physical development, to have lower academic achievement, and to engage in sexual precocious behavior and drug and alcohol use (Stattin and Magnusson, 1990)

7. Adolescent Physical Development • Late-maturing girls also suffer some adverse effects as the result of being treated like “little girls,” and they tend to be dissatisfied with their appearance. • In general, the negative consequences of early or late maturation are most severe when adolescents perceive themselves to differ from their peers. • By adulthood, many of the effects of early or late maturation have largely dissipated so that early-, late-, and average-maturers are fairly indistinguishable (Simmons and Blyth, 1987)

8. Adolescence according to Freud • Genital stage (age 12+): Libido is again centered in the genitals, and successful outcome in this stage occurs when sexual desire is blended with affection to produce mature sexual relationships. • Failure to resolve this conflict as a result of insufficient or excessive gratification of the id’s needs can result in fixation at this stage.

9. Adolescence according to Erickson • Ego Development Outcome: Identity vs. Role Confusion • Basic Strengths: Devotion and Fidelity • Up to this stage, according to Erikson, development mostly depends upon what is done to us. From here on out, development depends primarily upon what we do. And while adolescence is a stage at which we are neither a child nor an adult, life is definitely getting more complex as we attempt to find our own identity, struggle with social interactions, and grapple with moral issues.

10. Review: Erickson • Our task is to discover who we are as individuals separate from our family of origin and as members of a wider society. Unfortunately for those around us, in this process many of us go into a period of withdrawing from responsibilities, which Erikson called a "moratorium." And if we are unsuccessful in navigating this stage, we will experience role confusion and upheaval. • A significant task for us is to establish a philosophy of life and in this process we tend to think in terms of ideals, which are conflict free, rather than reality, which is not. The problem is that we don't have much experience and find it easy to substitute ideals for experience. However, we can also develop strong devotion to friends and causes. • It is no surprise that our most significant relationships are with peer groups.

11. FOR CONTRAST: Young Adulthood according to Erickson • Young adulthood: 18 to 35 • Ego Development Outcome: Intimacy and Solidarity vs. Isolation • Basic Strengths: Affiliation and Love • In the initial stage of being an adult we seek one or more companions and love. As we try to find mutually satisfying relationships, primarily through marriage and friends, we generally also begin to start a family, though this age has been pushed back for many couples who today don't start their families until their late thirties. If negotiating this stage is successful, we can experience intimacy on a deep level. • If we're not successful, isolation and distance from others may occur. And when we don't find it easy to create satisfying relationships, our world can begin to shrink as, in defense, we can feel superior to others. • Our significant relationships are with marital partners and friends.

12. Erikson’s “Identity Crisis” Expanded by Marcia (1987): • Four identity statuses (patterns) • Identity Diffusion: The adolescent has not yet experienced an identity crisis or explored alternatives and is not committed to an identity. • Identity Foreclosure: The adolescent has not experienced a crisis but had adopted an identity (occupation, ideology, etc.) that has been imposed by others (often the same-sex parent)

13. Erikson’s “Identity Crisis” • Four identity statuses (patterns) • Identity Moratorium: The adolescent experiences an identity crisis and actively explores alternative identities. During this period, an adolescent exhibits a high degree of confusion, discontent and rebelliousness. • Identity achievement: Adolescents who have resolved the identity crisis by evaluating alternatives and committing to an identity are “identity achieved”

14. Erikson’s “Identity Crisis” • Resolution: partially resolved by the shift from dependence to increasing independence. • Strategies used in early childhood to achieve separation may return during this process – e.g., negativism, or resisting any form of control, may reflect an adolescent's renewed efforts to assert their independence. • There may also be rebelliousness and acting out

15. Erikson’s “Identity Crisis” • Parent factors associated with successful adolescent identity formation include: • A willingness to negotiate with their teenager. • Providing the teenager with support and reassurance. • Allowing the teenager to develop his own point of view. • A family atmosphere that promotes individuation Hauser et al., 1987

16. Levinson’s “Seasons of a Man’s Life” • The early adult transition (age 17 to 22): entails leaving the world of childhood and forming the initial foundation for life in the adult world. Tasks include becoming independent from one’s parents and getting involved in college, the military, an entry-level job, etc. This transition leads to the formation of The Dream, the image of an ideal life that guides one’s decisions and choices.

17. Gilligan’s Relational Crisis • Girls ages 11 or 12 years old experience a relational crisis in response to increasing pressure to fit cultural stereotypes about the “perfect good woman” • As a result, they disconnect from themselves in order to maintain relationships with others. • Consequences: drop in academic achievement, loss of self-esteem, increase in vulnerability to psychological problems

18. Adolescent Self-Concept • Concern for physical appearance and how other perceive how they look. • Self esteem lowest during early adolescence (ages 12 to 14)

19. Adolescent Self-Concept • Renewed egocentrism: • Imaginary audience: Adolescents often feel as though other are watching or paying attention to them (i.e., as though they are “on stage”) • Personal Fable: Adolescents deeply believe in the uniqueness of their own experiences. This produces a sense of immortality and invulnerability to harm.

20. Adolescent Emotional Development and Experience • Critical tasks: learning how to cope with rapidly changing moods, particularly periods of feeling “down” • At risk for responding to boredom with unproductive activities. • Encouraged to take part in activities that allow them to experience feelings of personal fulfillment.

21. What the more recent literature says… AKA The Textbooks!

22. Hepworth, Rooney, and Larsen: The importance of rapport with adolescents • Adolescents who have had little or no experience of social workers have an extremely limited grasp of their roles • Adolescents, at least initially, are often involuntary clients and perceive social workers as adversaries, fearing that their role is to punish or to exercise power over them.

23. Hepworth, Rooney, and Larsen: The importance of rapport with adolescents • Warm-up periods are also important in gaining rapport with adolescents, many of whom are in a stage of emancipating themselves from adults and who are also frequently referred by those adults. • Consequently, they may be wary of social workers, and this is a particularly strong tendency among those who are delinquent or who are otherwise openly rebelling against authority.

24. Johnson and Yanca • Inclusion and participation • Group formats (discussion-activity-discussion structure) • Encourage prevention by reducing risk factors • Decision making and refusal methods • Role plays, assertiveness training, and similar techniques can be employed

25. Two common problems in adolescence Delinquency (externalizing problems) Self-harm and cutting (internalizing problems)

26. Delinquency • Child or adolescent engages in illegal activities • Etiology based on the research: parental lack of supervision and inconsistent (or harsh) punishment as highly correlated with delinquency and involvement with antisocial friends. • Also, young children identified as aggressive = high probability of delinquency in adolescence

27. Other risk factors: Male gender Low school expectations Low attachments to school Low achievement in school Poor verbal ability Poor school conditions (rundown school, poor monitoring) Family history of incarceration, violence, substance abuse and/or mental illness Low income status Living in a rundown neighborhood with a high crime rate Living in a dense urban community (Dryfoos, 1990; Loeber and Farrington, 2001) Delinquency

28. Delinquency • Best predictor or recidivism is age at first offense, younger the more likely they will re-offend. Child delinquents have a greater risk of becoming serious and chronic offenders than juvenile offenders. • Minor delinquent acts during adolescents are fairly common and usually not a sign of pathology – such acts are likely motivated by a desire to be liked by peers or to increase one’s self-esteem.

29. Self-harm and cutting • Behaviors involving self-harm (self-mutilation) often have onset in adolescence • “the deliberate destruction or alteration of one’s own body tissue without conscious suicidal intent” (Favazza, 1987, p. 225)

30. Self-harm and cutting • Associated with (rule out): • Sexual and physical abuse • Compulsive disorders • Eating and body images disorders • Difficulties with impulse control • Peer conflicts • Exposure to alcoholism and violence

31. Self-harm and cutting • Usually performed in secret • Addictive quality • Evoke strong feelings in the person, including shame and guilt • Many theories about reasons, most agree that it may be a means of emotional expression and control.

32. Self-harm and cutting • Other theories • Provide relief from feelings • Prevent dissociation • Elicit euphoric feelings • Express pain • Method of coping • Form of communicating with others • Self-nurturing or self-punishment • Re-enact experiences of being abused • Way of establishing control

33. NASW Standards the Practice of Social Work with Adolescents • Knowledge of Adolescent Development • Assessment • Knowledge of Family Dynamics • Cultural Competence • Self-Empowerment of Adolescents • Understanding Adolescents’ needs • Multidisciplinary Case Consultation • Confidentiality • Work Environment • Advocacy • Policies of Effective Practice

34. Knowledge of Adolescent Development Essential areas of knowledge and understanding about positive adolescent development include: ■ human growth and behavior, including developmental stages, human needs, motivations, feelings, behaviors, activities of children and youths, and cultural differences ■ the role of adolescence in individuals’ social, physical, emotional, and sexual growth, including adolescents’ striving for and ambivalence about independence, competence, achievement, personal identity, and sexuality ■ the critical role of education in healthy adolescent development and the barriers to a successful educational experience ■ the necessity to recognize the needs of adolescent development ■ the impact of substance abuse and violence on adolescents’ development and on their families ■ the family, school, community, and cultural process for allowing and helping adolescents become independent ■ the importance of opportunities for adolescents to establish positive relationships with open expression of thoughts and feelings with family members, peers, and role models such as teachers, clergy, and sports team coaches ■ the significance of adolescents’ steps in establishing an identity, which may include a natural form of rebelliousness and rejection of authority.

35. Assessment Social workers shall possess the following fundamental knowledge and skills to work effectively with adolescents and their families: ■ the history and development of social work and its person-in-environment perspective ■ the theory, principles, and methods of social work, including casework, group work, community organization, administration, supervision, planning, and research ■ the influence of cultural beliefs, background, lifestyles, and ethnicity ■ the interrelationships among the individual and the family, the group, the neighborhood, the community, and social systems ■ the purpose, structure, legal mandates, and services provided by public and voluntary social welfare, child welfare, and youth services agencies; schools; and health, mental health, juvenile justice, and law enforcement organizations ■ an ability to coordinate with other professionals and community organizations and advocate for their involvement on behalf of youths

36. Assessment ■ the political and economic factors affecting adolescents, their families, and their communities ■ multidisciplinary and team approaches for working with children and youths, and the contributions from biomedical, psychological, social sciences, legal, educational, law enforcement, and other disciplines ■ opportunities available to adolescents for training to increase job-related skills ■ an understanding of the importance of working with adolescents in the environments in which they feel comfortable, including nontraditional environments ■ familiarity with groups who provide peer education and improve youths’ decision making and leadership skills ■ understanding of and ability to develop a case plan jointly with youths and their families ■ an understanding of how to develop programs that provide comprehensive services to adolescents to prevent fragmentation ■ an understanding of how to develop programs that will increase the likelihood that youths will use available services for the range of issues that affect adolescents (for example, reproductive health, HIV/AIDS and other STIs, violence, and abuse).

37. Knowledge of Family Dynamics NASW defines families as two or more people who consider themselves “family” and who assume obligations, functions, and responsibilities generally essential to healthy family life. Essential areas of knowledge about family dynamics include ■ family dynamics in traditional and nontraditional families, including two-parent, single-parent, and foster and adoptive families and unrelated individuals living together as a family, and acceptance and understanding of such family constellations ■ the impact of adolescents’ parents’ growth experiences, attitudes, and behaviors and culturally relevant ways for parents to ask for help

38. Knowledge of Family Dynamics ■ an understanding of how to bring about changes in family functioning ■ the concept of family culture, including the role of the family in meeting the changing physical, mental, spiritual, and emotional needs of adolescents ■ cultural attitudes toward the responsibilities of each family member ■ the impact of impairment and disability, including mental and emotional disabilities, chemical dependency, and abusive conditions on positive adolescent development and family dynamics ■ an understanding of changing parental roles and the diversity among those roles ■ the impact of economic, social, and cultural conditions on parental ability to meet family responsibilities.

39. Self-Empowerment of Adolescents Social workers should demonstrate the necessary knowledge and skills to ensure the participation of adolescents in decisions about the programs and services designed to meet their needs. This includes ■ encouraging youths and their families to be active participants in their case planning and service delivery ■ developing adolescent leaders to provide peer support to other adolescents and supporting their efforts ■ advocating for youth positions and roles of influence on agency boards or committees and providing training for youths to develop the skills needed to improve existing services and develop necessary services ■ working with youths and their families to help them assume responsibility for following through on a plan of action and for securing and using planned services ■ providing or brokering the training and support to help youths develop independent living skills.

40. Understanding Adolescents’ needs Social workers who work with adolescents should respect and work to strengthen the many protective factors that are sometimes overlooked or ignored. Appropriate and effective work with adolescents requires an understanding of the developmental skills and tasks characteristic of the age, an awareness of the psychosocial and emotional phases of adolescence, and clinical knowledge of inappropriate behavior and symptoms of mental illness or stress. Social workers should be aware that adolescents’ behaviors and attitudes may provoke ambivalent or negative feelings in those who work with this age group. Social workers need to be aware of adolescents’ multidimensional lives, regardless of service focus. This includes the family, siblings, extended family, individuals with whom the adolescent may reside, peer group, friends of the opposite sex, religious affiliation, physical and mental health, cultural and economic facts, refugee status, discrimination experiences, and exposure to violence in the community or family or from war experiences. In advocating for adolescents, social workers must work to ensure that

41. Understanding Adolescents’ needs ■ continuing education is available for providers, professionals, and families of adolescents to develop skills and a knowledge base, to acknowledge and enhance adolescent protective and resilient factors, and to strengthen empowerment capacities and decision-making skills ■ community services are responsive to the mental health, physical, medical, educational, vocational and occupational training, housing, and other needs of adolescents as articulated by adolescents and their families ■ agencies provide opportunities for staff to recognize and take appropriate actions to resolve their own biases, fears, or antipathy about behaviors exhibited by adolescent clients

42. Understanding Adolescents’ needs ■ policies and programs adjust, change, or accommodate to meet the needs of adolescents in different settings and with different disabilities or mental or physical limitations ■ opportunities are provided for adolescents to discuss, learn about, and appreciate the uniqueness of different cultures, personalities, and interactions ■ knowledge is increased about medical and substance abuse issues, methods of fostering healthy attitudes, interventions, and behavior toward drug use among targeted youths ■ improved school connections are encouraged to improve academic performance, school attendance and behavior, and attitudes toward learning and achievement ■ opportunities for strong relationships with adults and peers for positive and supportive interaction are available

43. Understanding Adolescents’ needs ■ information about model programs for prevention and treatment is available ■ information is disseminated on the effects of alcohol, substance abuse, domestic and dating violence, and HIV/AIDS to families and communities ■ information, news, and updates about pressures on adolescents from different cultures, income levels, and ethnic groups are routinely provided ■ opportunities to identify and address risk-taking behavior are available in community forums and parent groups, as well as with educators, juvenile justice staff, and law enforcement officials ■ opportunities for collaboration among community, religious, and athletic groups are supported ■ opportunities exist to recognize adolescent achievements.

44. Confidentiality Respect for the client as a person and for his or her right to privacy underlies the social worker–client relationship. Except for federal, state, or local legal and other overriding requirements, the social worker will share information only with the informed and signed consent of the youth, the family, or both. Although assurance of confidentiality enhances the relationship and the willingness of the youth to develop and adhere to a case plan, the youth should be advised that there are circumstances in which confidentiality cannot be maintained. These situations may include ■ suspicion of child abuse or neglect, which requires that appropriate authorities be notified ■ suspicion of danger to the youth or to others. In all such situations, the social worker shall advise the youth of the exceptions to confidentiality and privilege, shall be prepared to share with the youth the information that is being reported, and shall appropriately address the feelings evoked.