A study of home-based services for families of adolescents

Adolescents and their families present some of the most difficult challenges for family-centered, home-based service providers. A study of 51 families of adolescents, who received services from one rural home-based program was conducted in order to describe the characteristics distinguishing families in which placement was averted from families in which placement was not. Content analysis of case records indicated group differences on severity and type of adolescent behavior, family functioning, and families' follow-up with discharge recommendations. Gender differences in placement rates were also noted. Implications for the provision of family-centered, home-based services to families of adolescents were discussed.     

Borderline Personality Disorder and Adolescence

SUMMARY

This chapter addresses many of the potential challenges clinicians face when working with adolescents with BPD. First, we present the diagnostic issues related to an adolescent population. Second, we review issues related to the families, peers, and larger systems (e.g., schools) that reciprocally influence the adolescent and the treatment. Third, we discuss specific treatment concerns and propose solutions, including how to effectively manage therapists' own reactions to working with this population. Many of the clinical vignettes and suggested interventions in this chapter derive from our experience working in an outpatient adolescent Dialectical Behavior Therapy (DBT) program. As described later in this book, DBT is an evidence-based treatment effective for suicidal multi-problem individuals with promising data published with suicidal adolescents diagnosed with borderline features (Rathus & Miller, 2002).     

FAMILY ASSESSMENT DEVICE: REPORTS FROM MOTHERS, FATHERS, AND ADOLESCENTS IN COMMUNITY AND CLINIC FAMILIES

This study compared responses on the 60-item version of the Family Assessment Device (FAD) obtained from mothers, fathers, and adolescents in two groups of families. The clinic group consisted of 94 families in which the adolescent had been referred to a mental health service in metropolitan Adelaide, South Australia. The community group consisted of 94 families, also containing an adolescent, living in the Adelaide community. Members of the clinic families consistently rated their families as less healthy than did families in the community. Importantly however, adolescents in both groups of families rated their families as significantly less healthy than their parents. Thus, while the results of the study provide support for the discriminative validity of the FAD, they also emphasize the need to consider separately self-reports on family functioning obtained from different members of the same family.     

The Contribution of Internal and External Resources to Emotional Adjustment: A Comparison of At-Risk and Normative Adolescents

The article discusses the differences between normative and at-risk adolescents with regard to the contribution of background variables (gender and age), internal resources (mastery and emotional maturity), and external resources (parental support and peer support) to their emotional adjustment. The results indicate lower levels of mastery, emotional maturity, parental, and peer support among the at-risk adolescents, than the normative adolescents, and the former display more emotional symptoms. The findings also show that gender does not contribute to emotional adjustment in either research group. In the normative group, the age of the adolescent was found to have a small contribution. With regard to internal resources, while both mastery and emotional maturity were found to contribute significantly in the at-risk group, only the emotional maturity of the adolescent was found to contribute in the normative group. Of the external resources, contrary to the research hypotheses, the contribution of peer support was not found to be higher in the normative group. In both groups, and particularly the normative one, parental support contributed to emotional adjustment. The discussion suggests explanations for the research findings and their implications, as well as recommendations for further research.     

Adolescent Outcome Measures in the NLSY97 Family Process Data Set: Variation by Race and Socioeconomic Conditions

This study uses nationally representative data from the National Longitudinal Surveys of Youth 1997 to analyze adolescent outcome indexes (delinquency, substance use, and emotional and behavior problems) by gender, race, household income, and family structure. Results from analysis of variance show that family structure is correlated with better adolescent outcomes, even after controlling for gender, race, and household income. For example, adolescents from two-parent biological homes consistently reported significantly less delinquency and use of illegal substances such as alcohol, tobacco, or marijuana than adolescents from single-mother or stepfamily households. All adolescents and their parents in two-parent biological families reported significantly lower incidences of behavioral and emotional problems than adolescents and their parents in single-mother or stepfamilies. Other findings with respect to gender, race, and income, as well as some interaction effects, were also indicated by the analysis.     

Values and happiness among Asian adolescents: a cross-national study

Despite policy efforts to increase adolescent happiness, their impact has been unsatisfactory. Their limited impact may be rooted from a discrepancy between values that adolescents pursued and those that the policies were based on. To provide policy implications, our study aims to identify prevailing values for South Korean, Japanese, and Chinese adolescents and to examine the relationship between the values and self-rated happiness (SRH). A cross-sectional study was conducted using survey data collected on approximately 2000 middle and high school students (7th to 12th school grade) from each country in 2008. Firstly, an explanatory factor analysis was conducted to identify salient adolescent values from each country. Subsequently, a multiple logistic regression analysis was conducted for each population group to examine the relationship between the identified values and adolescent SRH after controlling for sociodemographic characteristics. We found that benevolence and altruism were positively associated with adolescent SRH in all three population groups. Patriarchy was associated with SRH positively in Chinese yet inversely in Japanese. Success pursuit was inversely associated with SRH in Korean. Policy efforts based on values of communities or social harmony may benefit adolescents’ SRH in these three countries.     

Associations of Marital Conflict With Emotional and Physiological Stress: Evidence for Different Patterns of Dysregulation

The goal of this study was to explore theoretically suggested but untested links between interparental conflict and stress physiology in late adolescence. A multi‐method study was conducted involving families (n = 42) who previously participated in the University California, Irvine site of the NICHD Study of Early Child Care and Youth Development; adolescents were 17½ years of age on average. Parent report and observer ratings of conflict, adolescent participation in a robust social‐evaluative stressor, and assessment of cortisol, cardiovascular, and emotional functioning were included. Marital conflict was associated with dampened physiological stress responses in adolescence but sensitized emotional responses, suggesting that conflict may be associated with problems integrating and coordinating emotional and physiological responses to stress.     

Adolescent Socialization in Rural Appalachia: The Perspectives of Teens,Parents, and Significant Adults

ABSTRACT

The purpose of this qualitative study was to explore the social networks of Appalachian adolescents to understand socialization strategies and goals. A total of 46 interviews were conducted with five families (mothers, fathers, and adolescents) and 11 socialization agents the families identified as exerting significant influence in the lives of the adolescents. Interviews were transcribed and then analyzed using principles of grounded theory. Five themes developed from the interviews: the importance of community to the socialization process, adult involvement and support, adolescent monitoring, teaching respect and responsibility, and adolescent autonomy. Results suggest the need for in-depth investigation of adolescent development within a variety of cultural and social contexts to more fully understand these processes.     

Social Capital, Savings, and Educational Performance of Orphaned Adolescents in Sub-Saharan Africa

We examine the impact of social capital on savings and educational performance of orphaned adolescents participating in a family-level economic strengthening program in Uganda. Findings indicate that if given the opportunity, poor families in Uganda will use financial institutions to save for the education of their adolescent youth. Moreover, although the results are mixed, overall, adolescents with higher levels of social capital and social support, including participation in youth groups, are likely to report better saving performance compared to their counterparts with lower levels of social capital and social support. The results point to: (1) the role for family-economic strengthening programs specifically focused on improving the educational outcomes of orphaned adolescents in sub-Saharan Africa, and (2) the need for adolescents to be encouraged to participate in youth groups since these groups seem to offer the much needed supportive informal institutional structure for positive adolescent outcomes.     

Adolescents coping with mom's breast cancer: developing family intervention programs

The purpose of this pilot study was to gain a deeper understanding of how adolescents are affected by their mothers' breast cancer and to discover their opinions about how future intervention programs should be designed. Three focus groups were conducted with a total of 10 adolescents. Findings indicate that adolescents' lives had been complicated by their mothers' illness, as they often felt burdened with additional roles and responsibilities. Adolescents suggested that future intervention programs should have the following elements: Adolescent group comprised of boys and girls within 4 months of cancer diagnosis; psychoeducation; target coping skills sensitive to girls and boys of different ethnic and racial backgrounds; and after the adolescent groups, have multiple-family therapy groups that promote shared family understanding and open communication between parents and adolescents.     

Adolescent postabortion groups: risk reduction in a school-based health clinic

A short-term postabortion group for adolescents was developed. Three groups were conducted in an adolescent mental health clinic within an urban high school-based health clinic. The clinical group experiences offered the adolescents an opportunity to integrate the experience of pregnancy and the abortion decision into their lives. At follow up, adolescents who participated in th postabortion counseling group indicated that they chose and used a method of birth control, did not repeat an unplanned pregnancy, and remained in high school.     

Multiple‐Family Group Intervention for Incarcerated Male Adolescents Who Sexually Offend and Their Families: Change in Maladaptive Emotion Regulation Predicts Adaptive Change in Adolescent Behaviors

The multiple‐family group intervention is an effective, yet affordable, 8‐week treatment that is conducted in a juvenile correctional institution in Alabama with adolescents who sexually offend and their families. Data from 115 incarcerated male adolescents and their male and female caregivers collected at pre‐, post‐, and 1‐year follow‐up were used to determine that problem behaviors (internalizing, externalizing) decreased over pre‐ and posttest and the significant decreases in maladaptive emotion regulation predicted those changes. Adolescent‐reported anxiety over abandonment and attachment dependence on parents increased significantly; these changes were predicted by decreases in maladaptive emotion regulation. Linear growth models were also fit over the 3 time points and indicate decreases in adolescent problem behavior and maladaptive emotion regulation.     

Profiles of the parents of adolescent CSA perpetrators attending a voluntary outpatient treatment programme in Ireland

A group of 22 parents of adolescent sexual offenders (PASO) was compared with a group of 19 normal controls (NC) and 10 clinical controls (CC) on demographic, developmental, personal adjustment and family environment variables. The assessment protocol included the General Health Questionnaire‐12, the Culture‐Free Self‐Esteem Inventory, the Child Behaviour Checklist, the Family Assessment Device, the Parent Satisfaction Scale and the Multidimensional Scale of Perceived Social Support. Compared with clinical and normal controls, more parents in the PASO group reported that they had been arrested or charged for a criminal offence; had personally experienced child abuse; and more of their adolescents had experienced child abuse, with emotional abuse being the most common form of abuse for both parents and adolescents. Compared with clinical and normal controls, more adolescents of parents in the PASO group had witnessed parental drug or alcohol abuse and had been placed in care outside their home. While parents in the PASO group did not differ from clinical or normal controls in terms of personal adjustment, their adolescents had significantly more internalizing behaviour problems than normal controls, whereas adolescents of parents in the clinical control group had significantly more externalizing behaviour problems than normal controls. Compared with normal controls, parents in both the PASO and clinical control groups reported more difficulties with general family functioning, roles, affective responsiveness, affective involvement and behaviour control and lower levels of parental satisfaction. However, the groups did not differ significantly in their levels of perceived social support. Copyright © 2003 John Wiley & Sons, Ltd.     

Parent-adolescent concordance on perceived need for mental health services and its impact on service use

Mental health service underutilization among African American adolescents is well documented, yet not fully understood. Discordance between adolescents and their parents on perceived need for seeing a counselor for an emotional need or psychiatrist for psychiatric or medical services may help explain low service use among this population. This exploratory, prospective study examined the relationship between parent-adolescent concordance on perceived need for emotional counseling or psychiatric services and mental health service use. The relationships between gender and perceived service need and concordance and adolescent severity of depressive symptoms were also explored. Parent-adolescent dyads (n = 108) receiving community-based adolescent outpatient mental health services responded to interview questions concerning their perception of whether an emotional counselor and a psychiatrist were needed in the past six months. Findings revealed low parent-adolescent concordance on perceived need for an emotional counselor and a psychiatrist. A greater proportion of adolescents reported a need than parents. There was no association between gender and perceived need for an emotional counselor and a psychiatrist. Lower rates of parent-adolescent concordance were found among youth reporting elevated depressive symptoms compared to youth reporting normal range symptoms. Concordant dyads kept a higher number of appointments than discordant dyads. Implications for clinical social work practice and future research are discussed.     

Exploring the needs of parents for achieving reunification: The views of foster children,birth family and social workers in Spain

BackgroundFamily reunification refers to the process through which children and adolescents under a measure of temporary separation (foster care or residential) return to live with their biological families. The research has begun to reflect a paradigm change in intervention and support for these families that affects the consolidation of reunification and the prevention of new processes of separation and reentry into the protection system.ObjectivesThis article examines the needs of parents who are susceptible to an educational intervention from a positive focus that contributes to the consolidation of family reunification.MethodEighteen semi-structured interviews were conducted and 22 discussion groups were convened with 135 participants (63 protection-system professionals, 42 parents and 30 children and adolescents). The data were analyzed through content analysis and were subject to peer revision.ResultsA series of parents' specific educational needs when their children return home was recognized. These needs can be the objects of family intervention based on a positive focus directed toward highlighting parents' strengths and are related to awareness of family progress, emotional management, giving and receiving help from other families and social support. The participants' comments show that feelings of self-sufficiency and positive reinforcement are fundamental for consolidation of the process.ConclusionsSocial support through formal and informal networks may be a path to explore for providing more and better support after returning home. Empowering families so that they can be agents of support for other families can be a way to consolidate reunification, allowing families to be active agents in the reunification process. In addition, listening to children's voices can be a good strategy for family consolidation.     

Characterizing Emotional Support Development: From Adolescent Best Friendships to Young Adult Romantic Relationships

This study examined development of emotional support competence within close friendships across adolescence. A sample of 184 adolescents (53% girls, 47% boys; 58% White, 29% Black, 14% other identity groups) participated in seven waves of multimethod assessments with their best friends and romantic partners from age 13 to 24. Latent change score models identified coupled predictions over time from emotional support competence to increasing friendship quality and decreasing support received from friends. Friend-rated emotional support competence in adolescence predicted supportiveness in adult romantic relationships, over and above supportiveness in adolescent romantic relationships. Teen friendships may set the stage for developing emotional support capacities that progress across time and relationships into adulthood.     

The Role of Emotion Processing in the Association between Parental Discipline and Adolescent Socio‐Emotional Development

This research investigated whether biases in processing threatening emotional cues operate as an indirect pathway through which parental harsh discipline is associated with adolescent socio‐emotional functioning. Participants were 192 adolescents (M age = 12.4), and their parents assessed over two years. Findings revealed two significant indirect pathways involving fear processing. Greater parental harsh discipline was linked to more emotional response inhibition difficulty for fear, which was linked to more depressive symptoms in the following year. Greater parental harsh discipline was also associated with more emotional response inhibition difficulty for fear, and thereby, more peer problems later. Findings suggest that adolescent emotional processing operated as an indirect pathway linking parental harsh discipline and adolescent socio‐emotional functioning within the broader social context.     

Parent-Child Synchrony and Adolescent Adjustment

This study of 984 children and their parents examined the correlates of adolescent psychosocial adjustment. Based on previous research, it was expected that parental involvement and limit-setting would predict conduct disorder scores and that variables associated with the parent-child relationship, particularly parent-child synchrony, would be more closely related to emotional adjustment and social relationship measures. Contrary to expectations, parenting practices were unrelated to adolescent conduct disorder, but family harmony and adult-child synchrony predicted all measures of adolescent adjustment. It is concluded that positive parenting is not something adults do to children, but a quality of the parent-child relationship characterized by family harmony and parental empathy. Implications for social work practice with adolescents and their families are identified.     

Adolescent Children of Alcoholics on Disclosure,Support, and Assessment of Trustworthy Adults

The aim of this study is to describe adolescent children of alcoholics’ (COA) perspectives on disclosure and support. COA reported assessing the trustworthiness of adults before disclosing their home situation. Before disclosure they may have raised their own level of consciousness, told a peer, told an adult stranger, or in-directly communicated with an adult. These findings are the result of interviews with 27 adolescents attending support groups for COA in Sweden. Adults, who ask questions, listen carefully and cooperate with the child/adolescent, and who are knowledgeable about families with alcohol problems, are considered as supportive and trustworthy. The adolescents reported psychological, communicative, environmental, and generational aspects of the disclosure process.