Journal of Adolescent Health and Welfare

Volume 9 - No 1 - Spring 1996

Incorporating the Newsletter of the International Regional Chapter of the Society for Adolescent Medicine

Letter from the editor -

Dear Colleagues,

Yes, we are into our anniversary Year! And what an exciting year it promises to be. ..!

We begin the year with a milestone event on 4th February when young mothers, their children and their families meet for a reunion at Youth Support House.  These are the young families who formed the cohort of pregnant schoolgirls involved in our londitudinal study of teenage motherhood. So far this study has lasted 15 years and the results are fascinating; sometimes encouraging - girls who have struggled with immense hardship to raise young families; sometimes tragic -  young mums who died leaving their parents to bring up their children; but always significant and moving. It is great that so many young mums (over 100)  are willing to give time and effort to remain involved and provide us with important data to help the next generation of young girls. The results of the first ‘leg’ of the study were published in ‘Are you my sister, Mummy’ and the added information 2yrs to 15 years will be published in the summer - in time for our conference.

The year’s events continue with a Charity ‘Dog Night’ at Catford Stadium on 30th May - this time to raise money for our counselling centre at 3 High Street Penge - We now have three ‘shops’ in Penge - No 3 (counselling); No 5 (workshop and sales); No 7 ‘Warm Fuzzies’ pet shop project.

The celebration party will be on Friday 21st June 96 - midsummer day - which is exactly 10 years to the day when our first Youth Support event took place - the ‘Jamaica benefit’ fair. This time we will be having the ‘Blues Brothers Experience’ instead of Keith’s reggae sound system.

The main scientific event of the year will be our day conference at the Royal College of Physicians on 24th October. .. so the year should have something to cater for all tastes ... see you there!

Best wishes,

Diana Birch

Director Youth Support

YOUNG MOTHERS AND HOME-START

Sheila M. Shinman

Department of Education, Brunel the University of West London

This article draws attention to what life is like for some mothers who were schoolgirls when their first babies were born, to ways in which one of the services increasingly available to young families under stress operates to help them and to some of the issues arising.

In the first three months of  1993, 500 families participated in a nationwide study that provides some insights into the needs of vulnerable families under stress. (Shinman,1994). All had accepted help from Home-Start, a home visiting service that offes support, friendship and practical help to families with children under five.

A mere 5% (25/500) of all the mothers were in their teens at the time of the study. Most wre 15 or 16 when they had their first child (or children) and wee 17 in early 1993. But they were not a homogenous group. Very different patterning emerged between the nine mothers who were under sixteen and those who were older when they started their families.

The former all shared a history of childhood trauma. They had been in residential childrens homes or with foster parents and/or in and out of the care of the local authority. Those few who had been with their own families were found to come from backgrounds of violence, drug and alcohol mususe or other chronic problems. They were described as having “chronic, well established problems and a high risk of breakdown and need for child(ren) to be looked after by a local authority”, or “children at risk of ill treatment and neglect” or where “Home-Start was concerned that the family needed extra support to prevent breakdown and risk to children”, whereas older teenage mothers were placed by referrers and organisers in the category of “families where there are difficulties but no concern about breakdown or risk to children”.

So in addition to being in a younger age-grouping, technically children, the younger mothers laked the support of their own families - a crucial element in the well-being of mothers at home with young children (Brown and Harris, 1978) and associated with teenage mothers who found childcare relatively easy and unproblematic (Phoneix,1991).

This is not to say, in general, that very young mothers can be categorised in such a way. In another study of 533 teenage mothers the researchers also felt it important to draw attention to the small group of ten schoolgirl mothers; most were living in the family home and all but one received financial support from their parents.(Simms & Smiths,1986)

It is rather to emphasise the existence of a small number of mothers scattered around the country who can easily be marginalised  or lumped together with teenage mothers as a whole so that some of the issues that face them are overlooked.

The Youngest Mothers

All the ‘very young mothers’ lived in urban areas or small towns. Four, of whom one was registered disabled, were in unstable occasionally violent relationships. They lived on the upper floors of council flats with all the well-documented disadvantages for mothers with young children that that entails (Richman,1974). Estates were run down and inaccessible for anyone without their own transport. None of the mothers had cars or access to one. Four mothers lived alone in temporary private rented accommodation described as sub-standard (damp, mouldy, blocked drains). One lived in an owner occupied house belonging to her father.

It is striking that their natural mothers were either dead, had left the family home or, in one case, had a difficult relationship with her daughter. One 16 year old, for example, with a set of twins and expecting again had never known her natural father. Her mother, who had a mental disorder, rejected her daughter when she first became pregnant. So at the age of 14 she had been in foster care until her twins were born and then moved into temporary rented accommodation. The twins were on the Child Protection Register and she herself had formerly been on it.

Families were well established by the ages of 16 and 17. Three mothers had one child; five had two children including one set of twins; one had four under fives including a set of twins. Three of the mothers were also pregnant.

Four mothers were still of statutory school age. One of them was receiving occasional home tuition. None of the others had any formal education in spite of their legal educational status. One was described as a ‘slow learner’ and another as ‘immature’. There were suggestions that they were victims of undesirable peer pressure or possible sexual abuse. None of the 17 year olds were at school or college or in paid employment.

Against such backgrounds it is hardly surprising that mothers said that they felt lonely and that no one cared about them. They were alienated and most lacked child care skills. They had very little idea how to handle money or how to feed and cook for themselves or their babies. Pregnancies were seldom straightforward. Yet at the time of referral two of the three pregnant mothers wree not attending ante-natal clinic. Several babies were not thriving, beling below weight for dates, subject to spells in hospital and to chronic problems, particularly eczema and asthma.

These mothers (children of school age when they had their babies) were surviving but they were grappling with the most fundamental problems. Without schooling and qualifications, they had little chance of getting a paid job. Without a job they could neither afford child care nor get themselves satisfactory accommodation.  It was a Catch 22 situation. They were classic examples of the view that their   “life choices are few and most of them are bad”.(Cambell,1968)

The Home-Start response

In common with many other helping agencies, Home-Start cannot hope to alleviate the root problems of unemployment, poverty and lack of affordable housig. Nor is it possible to turn the clock back and change the home and school environment which arguably played a crucial part in the ways each individual developed. Home-Start organisers and volunteers have to respond to each family as it is.

Layers of need

The process is rather like peeling an onion. As one layer is removed another is revealed. Health visitors, social workers and others who refer mothers tend to give very general reasons - “support”,”befriending”,”parenting skills”. These perspectives become broader and, paradoxically, more focused first  by the organiser and then by the volunteer as they both take the time to listen to a mother and become aware of the dynamics of the family. For example, a probation officer requested ‘support’ for a 17 year old mother when her baby was discharged from a Burns Unit and placed on the Child Protection Register. At the time of referral the mother was on probation for arson’; she had two children including a fifteen months old toddler. She was also six months pregnant, and a chain smoker. There were concerns about the children’s health (persistent diarrhoea),safety and hygiene (there were no laundry facilities). The baby was losing weight.

The referrer’s prime concern was that the mother should have help with the new baby when it arrived, with budgeting and with keeping hospital appointments (Layer 1). Having visited  her at home the organiser picked up on the need for help with discipline and routine for the older chidren, on incipient speech problems with the toddler and on the insecure relationship between the mother and father (Layer 2).

A volunteer was matched with the mother before the baby was born. This strategy was thought to have advantages as it can take a considerable time to establish a mother’s trust and confidence. A Home-Start organiser usually tries to agree some practical help that a mother would appreciate. It is easier for volunteers and families to talk about something concrete rather than an abstract concept like ‘support’ or even ‘friendship’. In this instance, the mtoher suggested the need for clothing for the new baby; (Layer 3). She also accepted the offer of help with transport to and from hospital to keep ante-natal appointments. In the first four weeks, records show that the volunteer visited an average of three hours and forty five minutes each week. Just  undeder half the total time (49%) was spent in providing emotional support towards the children through play, hugs and praise (Layer 4). Just under one third of the time (30%) was taken up with direct support for the parents, building up a routine with the children.

Establishing links with health professionals through encouragement and provision of transport to clinic appointments accounted for a further 21% of the volunteer’s time. In the second month she began to work alongside their mother, to share ‘little wrinkles’, to do with choosing and buying food 0 they also went shopping together and she brought toys for the children and continued to play with them. Then followed positive reinforcement of the mother’s growing enjoyment in joining in the play. In the third month the volunteer also spent time listening as she began to talk about her underlying worries (Layer 5)

Just occasionally a mother is reluctant or refuses to accept home visits. This can be very difficult for young mothers who are living in poor accommodation or whose partner does night work. Take Jennie, a single mother who has had two children in 18 months and is pregnant again (but without ante0natal care). She lives on the second floor of a private rented flat on an estate on the outskirts of the town. It takes her over an hour to get to her doctor and to the nearest clinic. For her, the cost of transport is prohibitive.

Her health visitor was concerned because she tended to go off with “undesirable friends” and not to take care of herself (Layer 1). The organiser said the same thing, but in a positive way so that clear goals could be established. She needed 1) “more stable friends from her own age group”  2) “housing advice” and 3) “ante-natal care” (Layer 2). The volunteer specified 4) “an improved diet”, 5)”clothing and equipment - particularly safety equipment for the child, and finally “life skills” (Layer 3). These meant greater assertiveness, being able to say “‘no’ and to insist on safe sex.

Records show that at the outset Jennie agreed that transport to the clinic would help her and she would like to meet other people of her own age, but she refused a weekly home visit from a volunteer. Nevertheless, she was happy to try the weekly ‘drop-in’ group run by the organiser for mothers for whom perhaps no volunteer was as yet available or who, from being very withdrawn, had reached the stage of wsanting to join a group.

Over the three months study period, by dint of providing transport, Jennie was at least receiving regular ante-natal care. New and more positive friendships with other young mothers through integratio into the Drop-in were observed. She demonstrated greater interest in the coming baby by choosing clothing and by accepting suggestions about using safety equipment. There was still a long way to go before the family would no longer be a cause for concern, but marked improvements in the areas initially identified by the referrer were manifest.

Positive qualities on which volunteers found they could help mothers build and raise their self-esteem as a first stage in developing coping strategies were their strong will,s their desire to keep their babies and their willingness to learn.

Whilst all the mothers needed practical help and emotional support, the particular ways in which needs were met varied considerably. The range of volunteer activities included help in house exchange, attending court cases and case conferences, advocacy, outings (these could be very important for many of the young mothers had very little fun in life), helping with breast feeding and in establishing a routine in the family, and by ‘being there’ in unsocial hours. Organisers maintained links with the referring and other agencies and were sometimes able to alert professionals of the need for advice and to reassure the family about accepting it.

Concluding comments

These ‘snapshots’ offer a tantalising glimpse of the lives of some very vulneable adolescent mothers and what Home-Start, one among many other agencies, does to suppor them. Although part of a tiny minority - latest figures show 3,800 births among 13-15 year olds, a rate of 4.6 per thousand (OPCS,1991) - findings raise questions for natinal and local policies that can be seen to undermine the abilities of any parents to care properly for their children. Many difficulties stem from or are exacerbated by poverty. Lack of washing facilities, loneliness and insecurity result in poor hygiene, poor diet and depression. Yet young mothers receive less benefit because they are under eighteen on the false assumption that they necessarily have or can have financial support from their parents.

Those who had been looked after by local authorities appear to have lacked appropriate role models, emotional support and adequate preparation for parenthood. They needed not only to develop parenting skills but, if they are to escape from welfare dependency, a good educational base and vocational training - yet they are not in a position to benefit from youth training schemes.

Finally, policies which stigmatise and effectively ghettoise our youngest mothers in sub-standard accommodation in estates which are far from amenities and not served by affordable public transport undermine health promotion programmes that these families desperately need. If young families like them are, as Furstenberg (1987) has shown can happen, to “stage a recovery that does not fit in with the popular image” and if they are to benefit from services intended to help them, then these are issues that have to be addressed.

References

Brown,G.and Harris T.(1978) The Social  Origins of Depression,London,Tavistock Publications

Furstenberge,F Jr.,Brooks-Gunn J.,Morgan S.P., (19787) Adolescent Mothers in Laer Life , Cambridge University Press

Office of Population Censuses and Surveys (1991) Birth Statistics Series HMSO

Phoenix A.,(1991) Young Mothers,Cambridge Pol Press

Richman N (1974),The Effects of Housing on Pre-school Children and their mothers, Developmental Medicine and Child Neurology 16: 53-8

Shinman S.M.(1994) Family album, snapshots of Home-Start in words and pictures, Home-Start UK,Leicester

Simms,M and Smith C,(1986) Teenage Mothers and their Partners, London HMSO

- International Chapter News -

News of the International Regional Chapter (IRC) of SAM

(Society for Adolescent Medicine)

Co Chairs - Diana Birch Gustavo Girard   Treasurer Aric Schichor

London      Buenos Aires              Connecticut

England     Argentina                 USA

The 1996 SAM (Society for Adolescent Medicine) meeting -

“Assuring Quality Care for Adolescents - Preparing for the 21st Century”

will be held at the Crystal Gateway Marriott Hotel, Arlington Virginia on March 20-24th 1996.

Walter Rosenfeld, the programme chairman has put together a good variety of events and we will be having our usual IRC international sessions.

The International interest includes the following -

Wednesday March 20th 1996 12 noon to 5pm Regional Chapter President’s Forum - views expressed by IRC chapter members will be put to the group (Diana representing IRC). Please communicate before meeting if you want any issue discussed. Feed back will be given at chapter meeting.

Thursday March 21st 4pm - 6pm - IRC Workshop - “The practice of Adolescent Medicine from an International Perspective” - not a stunningly exciting title - but hopefully it will be a devastatingly interesting workshop! The theme will be management of ‘difficult cases’ and the emphasis will be on clinical presentation and practical solutions. A number of case histories will be portrayed and there will be an opportunity for discussion and comparison of management styles from one culture to another. As usual I hope to include an ‘interactive’ bit - this has proved very succesful in the past worshops. If anyone has a case they would like to present please let us know as soon as possible. Also please encourage people to participate - this is not a very popular time of day - don’t slope off for a sleep before dinner!

Thursday March 21st 7.45pm onwards - International Dinner - informal off site again - everyone welcome  - details will be posted on notice board - keep your eyes open and sign up promptly - restaurant not yet selected so if anyone knows the area and can give some advice it would be much appreciated.

Saturday March 23rd 7.30am - 8.45am International Chapter Meeting - bring all your ideas and comments - try to stay awake - another popular time of day!

In addition - just so that Gustavo is kept working hard - he has a lunch meeting with Roger Tonkin on Thursday 21st at 11.45- 1.30 which may interest members of IRC.

The Manic depression fellowship has                           produced three publications aimed at                           raising awareness of mental health issues                     in young people. “Why did my life have to                        change?” is written by young people who                     have grown up with a parent who has the                    diagnosis of manic depression. This is free to young people and costs 50 pence for professionals.

“Do you find yourself touched by madness?” is a student information pack written by a young undergraduate and the third publication which is of use to professionals working with young people experiencing mental health problems is entitled “Inside out - a guide to self management of manic depression”

All are aviailable from MD fellowship at

8-10 High Street, Kingston upon Thames, Surrey KT1 1EY.

Nona Dawson has been associated with Youth Support almost since the beginning.

In 1987 we published her survey of  educational  provision for schoolgirl mothers.

Now in our anniversary year it is fitting that we should publish her updated survey.

See over -

NEWS - NEWS - NEWS - NEWS - NEWS - NEWS

Good news for us in the new year!

We have just heard that we will be receiving a grant from the National Lottery - this will go towards making a new sitting room / recreation area for residents at Youth Support House. This is a very necessary development since it is hard sometimes to give residents time with their visitors while at the same time not allowing visitors free range of the house. Now we will be able to have a ‘social area’ where visitors can be entertained while at the same time ‘being contained’.

Second good piece of news is that we have secured the leases on two further premises in Penge - so now we can continue our plane for counselling and advice and our Youth Workshop and charity shops.

We are having a lot of visitors in our anniversary year - we would love to see you at our open days - please ring and let us know if you are coming ...

The Journal of Adolescent Health and Welfare

is published by:-

Youth Support

13, Crescent Road, London BR3 2NF

Charity No 296080

Tel No 0181 650 6296

Fax No 0181 659 3309