Parenting education for teen mothers with postpartum depression identification

Parenting Education for Teen Mothers

If a community values its children, it must cherish their parents. (John Bowlby)

Rationale of intervention population

Group based intervention programs

Multi-purpose programs

Teen Mother Empowerment Program Series (TMEPS)

Framework of TMEPS Program-Fig

Fig 2-Phased TMEPS

Phase 1 sessions

Table 1- Session Administration

Lesson Plans

Evaluation of program outcomes

Follow-up plan

Continuation of TEMPS

Appendix II-Program Evaluation Questionnaire

This paper is aimed at presenting a parenting education and support program for teenage mothers. To identify the most basic needs of teen mothers, literature review was conducted. Only recent literature, from 2006-2013 was reviewed. The review included intervention studies for teenage mothers and parents aimed at increasing the parenting skills of young mothers. Three basic set of needs was identified. Firstly, the teen mothers are in need of primary care for the new born child. Maternal health management is also main issue faced by teen mothers. Secondly, teen mothers require an effective and enabling social support structure for successfully raising the children in absence of socio-economic capacity of their own. Thirdly, the teen mothers are vulnerable to education discontinuation after giving birth in their teenage. A parenting education and support program named 'Teen Mothers Empowerment Program Series (TMEPS)' has been developed based on extensive literature review being conducted. The program has three main phases including primary care & parenting education, social support structure, and financial assistance for continuing education of teen mothers. 6 sessions of Phase 1 of TMEPS spanned over 6 weeks have been developed. Description of lesson agenda for each session is followed by brief description of all the six (6) lesson plans for this Phase 1 program. Evaluation methodology and criteria for assessing effectiveness of the program is also presented. A follow-up plan is also presented at the end of this work that includes Louisville Behavior Checklist (LBCL) and detailed assessment interview from participant teen mothers. The program is aimed at improving overall parenting behavior and skills of adolescent mothers.

Introduction

Background

Parenting is among the few jobs that require knowledge, insight, and education to rear children with healthy mind and body. Experience alone may not prove sufficient to raise healthy children. Raising children may become fun for the parents if they are well-informed about parenting skills and are ready to adopt these skills. With each child having different strengths, weaknesses, skills, and abilities, parents often find it difficult to adjust their 'parenting style' according to the need of their child. The problem is even more when parents, specifically the mother is a teenager and lacks not only the education but also insight to raising children. It is generally observed that young parents are neither economically nor socially stable to enjoy the joy of parenthood since most of the times they are struggling with routine issues of child in a perplexed manner. Thus, foundational parenting skills are vitally important for young parents, both for themselves and the child. The beliefs and perception of parents regarding child's physical and intellectual development also play an important role in determining the relationship of parents with child. Parents' perception about importance of academic grades also dictates the relationship (Areepattamannil, 2010). Teenage parents, specifically teen mothers are at a greater disadvantage both economically and socially in raising their children in a stable environment as compared to mothers of mature age. Thus, sensitivity of teen mothers towards their child's behavior also increases. With this background, this paper is aimed at presenting a research-based parenting education plan for teenage mothers.

Rationale of study

Genetic environmental transactions are responsible for a healthy upbringing of child. Adolescent pregnancies, poverty, and non-facilitating parenting (Wood & Davidson, 2006) have needlessly increased child population with special needs. Should there be an increased effort by educational institutes and community with respect to educating young mothers for raising mentally and emotionally stable child, a dramatic decrease can be achieved in number of children requiring special education or treatment. Further, there are direct and indirect impacts of adolescent pregnancies in areas of economic well-being, health risks, and child-care (Duncan, 2007). Child maltreatment due to lack of parenting skills (Reynolds, Mathieson & Topitzes, 2009) is also a main reason to address the issue of imparting appropriate parenting education. It is also a well researched fact that teen mothers are prone to live in poor conditions, suffer from hypertension, experience family and social instability, get few educational opportunities, and lack the requisite psychological strength (Petch, & Halford, 2008) as well as social security net to raise their children in a healthy environment. All these elements increase vulnerability of teen mothers. Health and well-being of mother and the child are compromised in such conditions. To help teen mothers and their children with an appropriate parenting education plan, this paper will devise the said plan for Hispanic Teen Mothers in Rio Grande Valley in Southernmost tip of South Texas.

Rationale of intervention population

Ethnic minorities of the U.S. are at an increased risk related to socio-economic factors and health. From joblessness to their legal status in the country, there are several other factors that impact their living conditions. Hispanics are by large one of the dominant ethnic minority and have both native-born and immigrant Hispanics. Exhibit 1 sourced from Texas State website indicates that there were more than 8.8 million Hispanics in Rio Grande Valley is a Hispanics dominated area in South Texas, thus the area qualifies for an application of teen mother parenting education program.

Literature review

Group based intervention programs

The issue of teen parenting and adolescent mothering is also investigated by the researchers in context of health problems, both for the mother and the child. Churchill and Clarke (2010) mentioned the role of governments in regulating teen parenting programs. The author observed that there is significant importance of investments in modifying relationships of young couples and their children. Multi-component programs based on group participation are observed to have effective outcomes in educating teen parents. Since there are several elements of teen parenthood that leaves adolescent mothers 'socially excluded', the research study conducted by Churchill and Clarke (2010) has been selected for review. This study specifically investigates teen parenting programs as an instrument to reduce 'social exclusion' of adolescent mothers and fathers. It is pertinent to mention that this Churchill and Clarke's research is in reference to programs and policies implemented in England. Research, development, and implementation of teen programs got started in the U.K before being adopted in the U.S. The role of Family and Parenting Institute (formerly National Family and Parenting Institute) has been significant in developing such programs aimed at reducing social exclusion of at-risk teen parents. Not only social inclusion of teen mothers is aimed through such programs but also 'behavior' management of children. Pregnant teenagers have been helped specifically through 'Family-Nurse partnership'. In 2008-09, grants and human capital support through £ 18.8 million Parenting Strategy Support Grant were provided by the U.K government to the local authorities. Family level interventions involving both mother and father along with individual intervention programs for teen mothers are two broad categories that governments have worked on. Following are the specific initiatives of the U.K government that were initiated as pilot projects and then extended due to their beneficial outcomes for teen mothers and fathers.

Provision of two parenting experts in each local authority

School-based Parent Support Advisers

Parent Know How Program 2008 (included free telephone service, online assistance, new media advice, and information service)

The role of parenting education intervention programs is effective in ensuring maternal health and increased bond between child and his/her parents.

The role of nurses and pediatrician in developing sense of responsibility and care towards the new born babies is important. The pediatricians are specifically observed to have vital role in influencing the teen mother behavior. Thus, both the government and social support organizations should develop programs that encourage the role of pediatricians and nurses in providing informal parenting education to teen mothers and fathers. The role of father in teen mother support has also been acknowledged by many researchers. Most of the studies that are aimed at intervening in teen mother parenthood for improving it, the lack of father presence and role has been noticed. The researcher is unsure regarding the sustainability of achieved outcomes by these programs since father is also most crucial for making these short-term successes regarding parenting successful. Lack of coordination or cooperation by father may reduce the improved aspects. Material support to teen mothers is usually provided by their parents or by male partners. In this case, the presence and counseling of fathers is essential. It is also observed that programs adopting daily class schedule may not result in optimal outcome improvement. Since there is a good detail of actions, thought patterns, knowledge, and information in the planned intervention classes, it is essential that teen mothers are able to incorporate this body of knowledge in their daily routine. Failure to do so may compromise the potential impact that the program can achieve in improving the parenting skills of teen mothers.

Multi-purpose programs

Most of the parenting education intervention programs are aimed at developing parent-infant interaction, multi-purpose services such as stress management, parenting skills development, and supportive child care. Most of the studies being reviewed by the researchers were observed to have smaller sample size with lack of suitable or appropriate comparison group mothers, and inconsistent measurements. The studies have indicated that six months program with weekly sessions and group as well as one-on-one sessions is most advantageous for teen mothers in developing parenting skills in them. Mollborn (2007) investigated the influence of teenage parenthood on the material outcomes of parents, specifically the teen mothers. The most important and negative outcome of teenage parenthood on both mothers and fathers was observed to be lack of education opportunities and non-completion of education post-high school. The author has reviewed pertinent literature to determine that teen parenthood has adverse impact on education outcome of both the parenting partners. The girls are even worse at attending post-high school forums of education. This not only result sin lack of economic opportunities but also the lack of social status that both or either of the parents could have achieved while not having a child in early teens.

This is an important study that holistically deals with the socio-economic outcomes for teen parents and the study is based on a reasonably large sample size. The primary data on which the study was based comes from the four waves of National Education Longitudinal Studies called NELS in years 1988, 1992, 1994, and 2000. Thus, the data is consistent and involves a large number of teen parents and non-parents for results comparison. The large size of sample is representative from the fact that in 1988 NELS involved 25000 students from 1050 schools. Education attainment was kept as the dependent variable is this study. The study observed key differences in teenage parents and non-parents. It was observed that average teenage mothers had 11.9 years of education equal to a high-school degree whereas the non-parent teens being surveyed had 2 years more education as compared to teen parent groups. They had 13.9 years of education. Another significant difference was that teen fathers attain even less education than teen mothers, approximately 0.4 years less than teen mothers. This indicates that since teen fathers have the responsibility to run their home, they are more likely to quit the education and take up jobs.

The roots of teenage parents to their behavior were also one factor that resulted in their parenthood. It was observed in the study that the teenage parents were educationally and socioeconomically disadvantaged even before bearing the child as compared to the teenage non-parents. Even before becoming parents, the teen mother received reduced price lunches and other social support services. This study was important in identifying major pre-conditions that resulted in teen parents' disadvantages they had to face after bearing a child in early teens. The teen mothers as well as the fathers were not academically sound as compared to their non-parent peers even before in eighth grade. The educational disadvantage of teenage parents started from eighth grade because of their socio-economic disadvantage and poor educational results. The material resources needed for the teen mothers were much greater than the non-parent teen girls. The study establishes a positive relationship between teen parenthood and education penalty.

The author has also identified the possible policy actions that governments can take to avoid the educational disadvantage of such marginalized parents that have children in early teens. Mothers are specifically identified as a potential group that can take advantage of any primary health and care facilities in their vicinities. The author has specifically emphasized the need for providing financial aid for teen mothers for completing high school and post-secondary education. This will help reduce the need for paid work that consumes much of the time of teen mothers and this directly reduces the amount of time and resources that teen mothers spend on education.

The study clearly develops a link between educational disadvantage and becoming teen parent. The study is exclusive and provides a deep insight into the socio-economic and other factors that may induce the teens becoming teen parents. This study also helps identify the pre-parent life of these surveyed teens. The teen parents had socio economic and other disadvantages even before becoming parents. The girls already had issues of underperformance in their academic life. Thus, schools and private NGOs can introduce educational and awareness programs as soon as 9th grade in the high school to educate the students regarding potential implications of becoming teen parents.

The girls can specifically be addressed in such programs. This way the policy makers will be working to prevent such cases of early parenthood and adolescent pregnancies. It may also be mentioned that once the girls have become teen mothers, the associated costs to their rehabilitation as fully participative and functioning member of society is difficult and time taking process. Thus, to minimize the negative implications and control the costs of unplanned and adolescent pregnancies, schools and social organizations should adopt a pro-active support. A behavioral survey in schools can be conducted to identify students showing tendency of becoming teen parents. And then such students can be offered counseling classes whereas pros and cons of becoming teen parents can be highlighted. This will also provide a reasonable chance to the would-be teen mothers of taking into account the potential implications their becoming mothers would have on them as well as the child.

Key, Gebregziabher, Marsh and O'Rourke, (2008) also identified the importance of early intervention program to prevent teen mother occurrences. The authors observed that as much as 50% reduction in birth rates for teen mother was observed in the study that involved 63 teen girls. The most effective procedures adopted by the researcher were medical care assistance, case management, and group meetings. However, group meeting resulted as being least productive in preventing second or subsequent births in teen mothers. Barnet, Liu, DeVoe, Alperovitz-Bichell and Duggan (2007) proposed a home-visiting parenting program for the teen mothers. The author premised that such program that involves home-visiting by the nurses and other professionals may result in improvement of parenting skills and knowledge, maternal life, and the primary care of child. The maternal life has a direct link with the improvement in parenting abilities of teen mothers. The authors identified many problems with teen mother going through repeated pregnancies. These are school dropout, depression, anxiety, and poor parenting by these mothers. The lack of development of mothering skills is an essential impediment in effective parenting.

122 eligible parenting adolescent mothers were selected to be administered with a parenting program based on home visiting. 84 out of these 122 mothers completed a baseline assessment and the results being compared against a control group. The pregnant adolescents were aged 14 to 18 years. These were low-income and of African-American race. Trained professionals were paired with each teen mother. The services were provided through the second birthday of the child. Adult-Adolescent Parenting Inventory (AAPI), repeat pregnancy, School status and depression (Center for Epidemiologic Studies Depression) were self reported by the participants of group. Parenting scores for the intervention group was observed to be 5.5 times better as compared to controlled group. The intervention teens were 3.5 times more likely to continue education however the program was not effective in terms of repeated pregnancy prevention and depression.

The programs being reviewed in the literature review segment highlights three major forms of interventions programs. Firstly, the use of group-based sessions for parenting education is most widely used intervention model. The second pervasive model in teen parenting education is home visiting but this has limited role in preventing repeated pregnancies that is an important impediment in achieving good health of mother and the child. The one-on-one sessions are most successful in their outcomes but only when held on weekly basis. The attention and monitoring that teen mothers receive through individual care is most useful when carried out by the pediatricians. The ability of pediatricians to influence the parenting style, behavior, and aptitude of teen mothers is more as compared to other professionals such as nurses and paramedics or social support specialists. Following section will present a parenting education program for teen mothers that are aimed at improving the parenting skills of teen mothers. This program will incorporate the key findings and address the limitations in existing teen mother parenting education programs.

III- Teen Mother Empowerment Program Series (TMEPS)

Introduction

The program is aimed at providing a unique teen mother education program aimed at improving the parenting skills of those adolescent mothers having difficulty in raising their new born babies. The review of literature has identified that the long-term impact of the programs already developed by researchers was limited or that effective monitoring mechanism was not present. The literature review also provided some background knowledge that programs aimed at correctly identifying the needs of teen mothers were beneficial in concluding that teen mothers are in need of primary care for child, social support structure, and financial support for continuing their education. The proposed program is in fact an integrated series of programs and does not involve a single intervention program. The objective of developing such a program based on series of programs was to present a holistic and all-inclusive parenting program for teen mothers. The literature review helped identify three main aspects of teen mother support that any parenting program must offer to help achieve better outcomes. These were:

Primary care for infant

Social support structure (This involves pediatrician advice, nursing support, peer and family group support)

Financial support for continuing education

Thus, these elements will be part of the proposed program along with addition of one more element called skills for employability. This will be included to provide opportunities of self-sufficiency to teen mothers that have children above 2 years of age.

Framework of TMEPS Program-Fig 1

The Framework is based on theoretical foundations of Social Learning Theory as used by majority of researchers (Barnet, et al., 2007; Key, et al., 2008; Mollborn, 2007). Social learning theory has been used as the theoretical foundation of intervention studies. The theory asserts that humans learn in social contexts. Thus, any learning regarding parenting taking place in social context is appropriate as intervention base. The framework then identifies the appropriate social context in which intervention programs can be designed. The observational earning and modeling techniques are appropriate to be used in this program. The researcher has developed three basic social learning programs, each aimed at providing different knowledge and skills to teen mothers. The first is the primary care program of new born babies for teen mothers.

Fig 2-Phased TMEPS

Phase 3

(24 months-36 months)

Financial Support

Phase 2

(0-4 Months)

Social Support Structure

Phase 1

(0-6 Weeks)

Primary Care

The three phased program is developed on the basis of social learning theory and has been developed as a series of programs. Each program is composed of different number of sub-activities to be performed in context of parenting education and support to teen mothers. Plethora of researches has indicated that the most immediate need of teen mothers is primary care of child the maternal health management. Therefore, phase one of this proposed program consists of child development and maternal health management stage.

Program Objectives

Phase 1 of the program is designed to achieve the following objectives.

Health management of teen mother and the new born baby

Decrease in second/subsequent pregnancies

Up to date immunizations of baby

Effective postnatal care

Healthy relationship development of mother with her child

Impart parenting education for informing mother regarding developmental stages of child

What to expect the first year (month-by-month). This objective will be served by describing common ailments and developmental signs of new born babies

Phase 2 and 3 have the objective of developing the capability of teen mothers to deal with mothering stress and making them learn stress management techniques

Phase 1 sessions

Although the program has been designed for full-rehabilitation of teen mothers after their adolescent pregnancy, including their financial and socio-economic revival, only phase 1 of the program will be described in detail that basically deals with parenting education program. Phase 1 will include detailed explanation of parenting program training. Since phase 1 is designed to last for 6 weeks, thus six (6) sessions will take place in Phase 1 with each session being conducted after one week. 6 different lesson plans will be used to impart the parenting education and training.

Table 1- Session Administration

Session

Venue

Agenda/Topic

1

Session 1

Hospital

Pediatric screenings of Child

Breastfeeding Lesson 1

2

Session 2

Hospital/Clinic

Breastfeeding Lesson 2

3

Session 3

Social Security Center

Mother Diet Planning

4

Session 4

Clinic

Child Development Benchmarks

5

Session 5

Social Security Center

Relationship Coaching

6

Session 6

Home Visit

Intellectual Development

Lesson Plans

Following are the tentative lesson plans for each of the six lessons in phase 1 sex sessions of parenting program.

Lesson Plan 1: On the second day of child's birth, the pediatrician will conduct regular screenings of the child and assess the overall health of mother and the child. The main activities in session one will be the first lesson covering the issues from breastfeeding, child behavior for first few hours, sleep timings. Breastfeeding is one of the most important issues to be addressed. The first lesson plan will provide explanation to breastfeeding issues of:

Sore nipples or breasts

Cracked nipples

Latching

How often to feed?

Lesson Plan 2: Session 2 being conducted in week two of the birth will also focus on breastfeeding issues. The importance of breastfeeding in good parenting cannot be ignored since breast milk not only provides readymade food for the new born but also helps remove risks of diarrheal morbidity (Lamberti, Walker, Noiman, Victora & Black, 2011). The positive impact of breasfeeding on mother as well as the child (Chung, et al. 2007) merits that two specific lessons on breastfeeding and issues involved with breastfeeding is included in the program. Lesson No. 2 on Breastfeeding will include:

How to handle fussy babies?

Milk Flow Issues

Breastfeeding Positions

Impact of breastfeeding on child

Impact of breastfeeding on mother

Right to breastfeed legislation

Lesson Plan 3: Breastfeeding mothers require an improved intake of nutrients and essential minerals in the initial 6 months of birthing a child. Since bodies of teen mothers are also growing, the need for good nutrient diet is essential for both the mother and the child. Mothers will be introduced to varieties of food that they must have in their daily diet. Mothers can then arrange for having these foods in their diet plan. The essential items that will be discussed with respect to their importance to the mother's diet are:

Milk

Non-fat and low-fat diets

Grain food

Green vegetables

Proteins

Fluid intake

Limitations of caffeine use

Essentials of daily diet for teen mothers

Lesson plan 4: Since most of the teen mothers are not stable, neither socially nor economically, they have fewer resources to get educated regarding the expected stages of child's development. Result is their ignorance to any lacking in their child or over-stimulation of child to get active and growing. Following concepts will be covered in lesson 4 of the Phase 1 program:

Weight control, weight benchmarks for child and mother

Measuring Body Mass Index (BMI)

The main stages of child development will be described in detail. These include:

Infancy: 4-6 months rolling over

6 months Sitting Unassisted

6-9 months crawling

9-12 months Crawling and walking (with aid or unaided)

Toddler: 1-3 years

Lesson plan 5-Relationship coaching: Teenage mother's relationship with her child is as strong as she understands the dynamics of parenting. This lesson will introduce the mothers with the importance and format of:

Safe sleeping of infants

Crying infants and calming techniques

Social, emotional, and intellectual growth of child through play activities

Relationship with child's father

Lesson 6-Intellectual and Financial: Conducted in home of each participant mother, this lesson will also be used so as to inform the counselor regarding home environment of teen mother and new born child. Lesson 6 in week 6 of the phase 1 program will cover presentations and panel discussion on:

Intellectual stimulation of child

Financial security of mother to promote healthy mother-child relationship

Achieving financial stability and gap between pregnancies

Evaluation of program outcomes

It is essential to evaluate the effectiveness of TMEPS program. Since Phase 1 includes direct intervention and only mothers successfully completing the initial phase 1 of TMEPS will be qualifying for phase 2 and 3, detailed program description has been drafted for phase 1 only. The evaluation framework will also be limited to gauge the effectiveness of this program related to Phase 1. This will help assess the effectiveness of first phase and then expand the scope of this program to next phase. Phase 1 of this program will be evaluated with respect to four criterions. These are presented in form of a table:

Sr. No

Evaluation Criteria

1

Knowledge Gained

2

Skills developed

3

Behavioral Change

4

Actions taken

Having developed evaluation criteria, both pre-test and post-test assessments will be conducted by administering a survey questionnaire to the participant teen mothers. The results will be assessed with a pre-test results held as a baseline indicator in each of the established criteria category. Three questions in each evaluation category (total 12 questions comprising of four categories) will be developed to record the responses of participant mothers. A five-point licker scale will be used to record the participant response. This will help quantify the results of evaluation process. This will enable the program developer and the trainer of program to assess potential limitations of program in context of program development or its execution. During this program, teen mothers will be assisted with primary care of child that includes developmental screenings (Insights, 2013) and immunization against diseases. Immunization has been included in the phase 1 program based on study conducted by DuMont, et al. (2008) in which the researchers observed that compliance with early immunizations improve health prospects and disease prevention of new born children. The phase 1 of TMEPS will last from 0 to 6 weeks. After conducting the evaluation of phase 1 program, qualifying mothers will be routed to second phase. Phase 2 includes support through social groups that will enable the mothers to feel secure and carry on with their mothering tasks positively.