Chapter 10: Small Group and Individual InterventionsBox 10.a
"I Have A Future" Combines Individual And Group-Based Work To Prevent Teenage Pregnancy
Meharry Medical College in Nashville treats primarily African American patients. Medical personnel and counselors realized that teenage pregnancy was a problem in the community they served. Following a needs and resources assessment they mounted a comprehensive project based on individual and group work which included counseling, employment skills, leadership development, and career advice. The program reached out to hundreds of teens who where devoid of opportunities to develop future plans for employment and education. By combining individual and group work teens could identify with others who were going through a similar situation. What is notable about this program is that in addition to personal and group support, workers at Meharry Medical College also engaged in advocacy and policy work. They knew that changes in individuals had to be accompanied by changes in the systems that put them at a disadvantage They involved religious congregations, human service agencies, African American business leaders and public agencies in their efforts to help the young people (Lewis, Lewis, Daniels, & D'Andrea, 2003).
Individual and Group Work Can be Used to Increase Resilience
According to Rutter (1987), there are four central mechanisms that can help people cope with adversity and develop positive mental health: (a) reducing risk impact, (b) interrupting unhealthy chain reactions stemming from stressful life events, (c) enhancing self-esteem and self-efficacy, and (d) creating opportunities for personal growth. Risk impact may be reduced either by altering the risk or by altering exposure to the risk. Altering the risk means changing it in some way to minimize effects. For instance, for young children to face a separation or new situation without preparation constitutes a risk. The risk for children who need hospitalization can be altered by taking them to visit the hospital before admission and by "practice separations" from parents in secure circumstances. Altering exposure means keeping the person away from the risky situation, or reducing involvement in its riskier aspects. For example, Rutter (1987) found that in high-risk communities, strict parental supervision of children's activities outside the home can reduce the risk for delinquent behaviour. Placing limits on what children can do and how long they can stay out minimizes exposure to the risky environment. The mechanism of breaking a potentially damaging chain reaction can be seen in a study of parental loss: ensuring sustained, adequate care breaks the chain of harmful consequences. A nurturing environment can protect children from the consequences of loss, separation, and other risks. Self-efficacy can be fostered in children by offering age-appropriate tasks and sufficient rewarding experiences of control. Finally, opportunities for personal development may be created by teaching youth social skills they can apply in various settings, and by preventing school dropout. This last mechanism may be conceptualized as promoting beneficial chain reactions. A good education can lead to attractive jobs, a higher income, and the like. Similarly, adequate social skills can lead to friendships, which translate into social supports that have the effect of buffering stress. All of these mechanisms can be put in place through individual and/or group work enhancing self-esteem, preventing exposure to risks, and opening up opportunities.