Jo=
urnal
of Adolescent Health and Welfare
Vo=
lume 9
- No 1 - Spring 1996
Incorporating
the Newsletter of the International Regional Chapter of the Society for
Adolescent Medicine=
Le=
tter
from the editor -
De=
ar
Colleagues,
Ye=
s, 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 f=
ormed
the cohort of pregnant schoolgirls involved in our lon=
ditudinal
study of teenage motherhood. So far this study has lasted 15 years and the
results are fascinating; sometimes encouraging - girls who have struggled w=
ith
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 ne=
xt
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 mone=
y for
our counselling centre at 3 High Street Penge -=
We
now have three ‘shops’ in Penge - N=
o 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 sou=
nd
system.
Th=
e main
scientific event of the year will be our day conference at the <=
st1:place>
Be=
st
wishes,
YOUNG MOTHERS AND HOME-START
Sheila M. Shinman
Department of Education, Br=
unel
the
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 particip=
ated
in a nationwide study that provides some insights into the needs of vulnera=
ble
families under stress. (Shinman,1994). All had a=
ccepted
help from Home-Start, a home visiting service that off=
es
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 ti=
me
of the study. Most wre 15 o=
r 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 bet=
ween
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 pare=
nts
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, dr=
ug
and alcohol mususe or other chronic problems. T=
hey
were described as having “chronic, well established problems and a hi=
gh
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 abo=
ut
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.(S=
imms
& 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 tee=
nage
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 sm=
all
towns. Four, of whom one was registered disabled, were in unstable occasion=
ally
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 a=
gain
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 s=
he
had been in foster care until her twins were born and then moved into tempo=
rary
rented accommodation. The twins were on the Child Protection Register and s=
he
herself had formerly been on it.
Families were well established by the ages of 16 and 17. Three moth=
ers
had one child; five had two children including one set of twins; one had fo=
ur
under fives including a set of twins. Three of the mothers were also pregna=
nt.
Four mothers were still of statutory school age. One of them was
receiving occasional home tuition. None of the others had any formal educat=
ion
in spite of their legal educational status. One was described as a ‘s=
low
learner’ and another as ‘immature’. There were suggestions
that they were victims of undesirable peer pressure or possible sexual abus=
e.
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 moth=
ers wree not attending ante-natal clinic. Several babies =
were
not thriving, beling below weight for dates, su=
bject
to spells in hospital and to chronic problems, particularly eczema and asth=
ma.
These mothers (children of school age when they had their babies) w=
ere
surviving but they were grappling with the most fundamental problems. Witho=
ut
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. I=
t was
a Catch 22 situation. They were classic examples of the view that their “life choices are few and mos=
t of
them are bad”.(Cambell,1968)
The Home-Start respons=
e
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 ha=
ve
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 - “sup=
port”,”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 liste=
n 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 arsonR=
17;;
she had two children including a fifteen months old toddler. She was also s=
ix
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 p=
icked
up on the need for help with discipline and routine for the older chidren, on incipient speech problems with the toddle=
r and
on the insecure relationship between the mother and father (Layer 2).
A volunteer was matched with the mother before the baby was born. T=
his
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 usu=
ally
tries to agree some practical help that a mother would appreciate. It is ea=
sier
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 w=
ith
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 hou=
rs
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 t=
he
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 a=
nd
buying food 0 they also went shopping together and she brought toys for the
children and continued to play with them. Then followed positive reinforcem=
ent
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 chi=
ld,
and finally “life skills” (Layer 3). These meant greater
assertiveness, being able to say “‘no’ and to insist on s=
afe
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 ag=
e,
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 bei=
ng
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 integrati=
o
into the Drop-in were observed. She demonstrated greater interest in the co=
ming
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 long=
er
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 desir=
e 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 adv=
ice
and to reassure the family about accepting it.
Concluding comments
These ‘snapshots’ offer a tantalising glimpse of the li=
ves
of some very vulneable adolescent mothers and w=
hat
Home-Start, one among many other agencies, does to sup=
por
them. Although part of a tiny minority - latest figures show 3,800 births a=
mong
13-15 year olds, a rate of 4.6 per thousand (OPCS,1991) - findings raise
questions for natinal and local policies that c=
an 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 le=
ss
benefit because they are under eighteen on the f=
alse
assumption that they necessarily have or can have financial support from th=
eir
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 a=
re
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,
Furstenbe=
rge,F Jr.,Brooks-Gunn J.,Morgan=
S.P.,
(19787) Adolescent Mothers in Laer Life ,
Office of Population
Censuses and Surveys (1991) Birth Statistics Series HMSO
Richman N (1974),The Effects of Housing on Pre-school Children and the=
ir
mothers, Developmental Medicine and Child Neurology 16: 53-8
Shinman S.M.(1994) Family al=
bum,
snapshots of Home-Start in words and pictures,
Simms,M and Smith
C,(1986) Teenage Mothers and their Partners,
Ne=
ws of
the International Regional Chapter=
(IRC)
of SAM
(S=
ociety
for Adolescent Medicine)
Co Chairs - Diana Birch Gustavo Girard Treasurer Ari=
c
Schichor
&nb=
sp;
&nb=
sp;
The 1996 SAM (Society for Adolescent Medicine)
meeting -
&#=
8220;Assuring
Quality Care for Adolescents - Preparing for the 21st Century”
will
be held at the Crystal Gateway Marriott Hotel,
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 followi=
ng -
Wednesday
Thursday March 21st
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 - b=
ring
all your ideas and comments - try to stay awake - another popular time of d=
ay!
In addition - just so that Gustavo is kept work=
ing
hard - he has a lunch meeting with Roger Tonkin=
on
Thursday 21st at 11.45- 1.30 which may interest members of IRC.
&#=
8220;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
Nona Dawson has been associated with Youth Support almost since the
beginning.
In 1987 we published her survey of educational provision for schoolgirl mothers.<= o:p>
Now in our anniversar=
y year
it is fitting that we should publish her updated survey.
See over -
NEWS
- NEWS - NEWS - NEWS - NEWS - NEWS
Go=
od
news for us in the new year!
We=
have
just heard that we will be receiving a grant from the National Lottery - th=
is
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 &#=
8216;social
area’ where visitors can be entertained while at the same time ‘=
;being
contained’.
Se=
cond
good piece of news is that we have secured the leases on two further premis=
es
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 Journ=
al of
Adolescent Health and Welfare
is publishe=
d by:-
Youth Sup=
port
13, Cresc=
ent
Road,
Charity N=
o 296080
Tel No 01=
81 650
6296
Fax No 01=
81 659
3309