Introduction
This paper will focus on the pregnancy center where this externship occurred, the services that were offered and why these services are important for both the individual clients and the community in which they live. This externship occurred at a pregnancy center that was focused on providing medical care and counseling for young women who believed that they were pregnant. The individuals that work at the counseling center have a genuine concern for the women that are seeking treatment from the center. The center provides a limited amount of medical care which includes pregnancy tests and ultrasounds. If a client requires further medical care the center provides referrals to other agencies that can offer additional services. If the client maintains a relationship with the center during the pregnancy the center offers material assistance such as maternity clothes and items for the baby.
In order to create an environment in which both the female and male clients are comfortable the staff at the center is comprised of both male and female peer counselors. The work environment at the center is flexible which allows the staff to switch their job responsibilities on a limited basis in order to assist clients with various tasks. This provides the clients with the option of having the same person assist them with receiving the full benefits of the center from the medical care to receiving the necessary material goods that re required when an individual is pregnant. This lessens the anxiety that the clients feel when meeting new staff members as they are going through a difficult time as well as provides the staff with knowledge about the entire organizations operations resulting in lower levels of staff burn out.
Statistics from the Center
The below statistics are from the previous year at the center. Regretfully while research has shown that the teen pregnancy rate has decreased throughout the United States teen girls between the ages of 15 and 19 are the second largest age group that receives some form of assistance or counseling from the center.
The chart also provides an interesting look at the break down between the number of single women and married women who utilized the services offered by the center. While it was predominantly used by single women with the total coming in at 1881 single women compared with 850 married women it is surprising that the number of married women as high as it was. It can be assumed that these women had only been recently married and feeling overwhelmed when they believed that there was a possibility that they could be pregnant.
Table 1: Statistics from the Pregnancy Center 2008 -2009
Note: Data developed from the Pregnancy Center Client Numbers – 2008-2009.
Note: Columns are divided by the names of the peer counselors.
The statistics about the ethnicity of the women using the services were interesting as well. While the center served primarily Caucasian women the second largest ethnic group receiving services were Hispanic women.
These statistics show that women of all ages, marital status and ethnicity are impacted when the possibility exists of an unplanned pregnancy. The services that are offered by the center provide these women with a supportive place in which to focus on their health as well as the children that they are carrying.
Services Offered by the Center
An unplanned pregnancy at any age is a frightening occasion. That is why there are many organizations that devote themselves to assisting individuals who find themselves pregnant make the appropriate choice for themselves and their baby. Each of these organizations has their own policies and procedures that are unique to their organization for how they are allowed to assist their clients. This center focuses on the positive aspects of becoming pregnant and supporting the women and men who find themselves in this unexpected situation. By providing counseling, material assistance and access to additional services provided by different agencies the center is able to promote values and an increase the sense of responsibility in these young men and women.
Psychological Reasons to Explain Unplanned Pregnancies
The young women seen in this clinic typically have been raised in environments in which inappropriate behavior was not discouraged and when combined with an advertising culture that bombards young women with the message that in order to be happy and popular they must drink and engage in other risky behavior such as unprotected sexual intercourse. The social ecological theory is used to provide care givers the understanding that is necessary when dealing with multiple sources influencing individual’s behavior (Raneri, Leslie G and Wiemann, Constance M, 2007). There are many factors that increase the risk of a teenager becoming a teen parent. Some of these include involvement with an older partner, poor relationship with their mother, a mother without a high school education or a mother who also became pregnant while still a teenager (Raneri, Leslie G and Wiemann, Constance M, 2007). These are risk factors that if discussed with a trained counselor who uses behavior modification and cognitive therapies could be altered.
It could be theorized that the individuals that find themselves in the position of experiencing an unplanned pregnancy due to one of the above reasons had not fully realized their potential during psychosocial development. Psychosocial development is one of the most well known theories in modern psychology. In this theory the ego identity is developed through various forms of social interaction. When an individual successfully navigates a social situation they feel a sense of accomplishment and fulfillment which leads to an increased feeling of competence. If an individual did not successful navigate one of these situations this feeling of competence is not developed which could lead to negative actions occurring to the individual as the social interactions that they are involved in become more complex and involved. By being able to make good choices about various situations they can avoid risky situations that could result in an unplanned pregnancy.
Another psychological theory that could assist researchers in understanding a potential cause of unplanned pregnancy is behaviorism. In behaviorism an individual’s behavior is influenced by the culture that the individual was raised in. Therefore if the individual grew up in a situation in which their family had financial troubles, unplanned pregnancy or a history of drug or alcohol abuse the child will be more likely to have similar problems using this theory. While it indicates a certain level of determinism in how an individual’s behavior is shaped, its theories are excellent at modifying an individual’s behavior to create a positive outcome.
There is a third psychological theory that is more current then both behaviorism and psychosocial development. Cognitive development is how the brain changes how it process information as the individual grows and develops. If an individual learns skills that will assist them in making proper choices that involve thought and planning. If an individual does not learn these skills then it increases the chance that he or she will be unable to function successfully as an adult or to make choices that will stunt the individual’s ability to succeed.
Researchers Experience
Many of the clients seen by the center have no concept of the risks or responsibilities that could result from these forms of behavior. Teen pregnancy rates have dropped 30% since 1990 due to increases in educational programs that promote abstinence or safer sex practices. However even through the occurrence of teenage pregnancies have decreased throughout the United States in 2006 750,000 women between the ages of 15 to 19 became pregnant (Raneri, Leslie G and Wiemann, Constance M, 2007).
During the time spent at the pregnancy center, it was observed that many of the clients were young females between the ages of 15 and 24. These young women came to the center because they believed that they were pregnant and needed to have the belief confirmed or refuted. If the test was positive they are then offered additional medical and counseling services. If the test is negative additional counseling sessions are offered in an attempt to change the client’s behavioral patterns. This is done in order to attempt the prevention of a second pregnancy scare while they were emotionally and financially unprepared for the responsibility. This additional counseling is provided in an attempt to prevent a future crisis pregnancy. As the individuals are already more likely to engage in risky behaviors due to the circumstances of how they were raised. Teenage mothers or teens at risk for a teen pregnancy are statistically more likely to have been raised in an environment with a lower socioeconomic status when compared to teenagers that do not have children. As a consequence of having children at such a young age when the individual is not emotionally or financially ready to have children will negatively impact the individual’s ability to continue with their educational plans and potential future earnings (Hotz, Joseph, McElroy Williams, Susan, and Sanders, Seth G). The children of teen mothers are then more likely to continue the cycle of teen pregnancies (Hotz, Joseph, McElroy Williams, Susan, and Sanders, Seth G).
Health Risks of Teenage Pregnancy
Teenage mothers and their children are at risk for more health problems then older mothers. The children have an increased risk of their children being born under the normal weight standards which increases the child’s risk for problems with development and behavioral issues (Raneri, Leslie G and Wiemann, Constance M, 2007). Teenage mothers also have a 42 percent chance of having a second child within 24 months of the first pregnancy (Raneri, Leslie G and Wiemann, Constance M, 2007). When the statistical information is compared between teenagers that are mothers and mothers between the ages of 20 and 29 the younger mothers have an increased risk for poor prenatal care, increased risk in delivering the baby early and the baby being stillborn (Raneri, Leslie G and Wiemann, Constance M, 2007). The medical concerns for both the teenage mother and the child combined with the statistics that indicate that once a teenager has one child they will continue to have additional children has created the need for intense counseling strategies with the intent to change the behaviors that resulted in the original pregnancy. The counseling services provided at the center attempt to create stronger support networks with a focus on faith based initiatives attempts to create a positive change in the lives of the families that require the centers services.
Client Profiles
Many of the young women seen in the clinic were not in stable long term relationships and many were still pursuing educational opportunities such as high school or college. As an example case study DD is 16 years old and has not yet finished high school and has no means of supporting herself or her child without parental support. Based on the age of this client she is not physically, emotionally or financially prepared to care for her child. The client was able to bring her mother to the clinic for the ultrasound appointment. This provides the client with at least one other person that is aware and supportive of the physical and emotional changes that will occur as the pregnancy continues.
In an average day when the young women entered the center, they have the opportunity to speak to a mental health consoler who established what sort of support network was available to her. Common examples of a support network include the father of the child, parents and support from a religious organization such as a church or synagogue. If the client does not have a strong support network the center is able to refer them to the church that is part of the center for additional counseling and support. The benefits of religious counseling allow the clients to expand their support network in a non-threatening environment.
A second example of a case where the client tested positive for pregnancy is LS. She was 17 years old and had been in a long term relationship for 1 year. They are both seniors in high school. At her initial appoint she was positive when speaking of the support that her boyfriend would be able to provide while also understanding that both sets of parents will be saddened but supportive of the pregnancy. She did not believe in abortion and planned to carry and parent the child regardless of the obstacles. The center then scheduled her for an ultrasound appointment and asked her to bring both her parents and boyfriend to the appointment. When she arrived for the appointment she was accompanied by her mother, her boyfriend and the boyfriend’s mother. This indicated that she had a very strong support network. She also had the benefit of a strong religious background in the Christian faith and attended church regularly. As is the standard policy for all new mothers the center offered to help with maternity clothes, referral to doctors and tell the family that we will help with diapers, crib, formula and a layette and clothes for the baby.
Regretfully for some individuals the second appointment when the individuals that make up the support network are brought together does not always create a positive outcome. This is an emotional time for both the women and their families and there are instances where when the parents are brought to the center that these emotions erupt creating the potential for violence. When the threat of violence does occur it requires the individuals at the center to intervene in the situation by separating the parties involved and even to call the local law enforcement agency if the situation continues.
This course of action recently occurred at the center with one of their new clients. The client who will be referred to as BB in this document came to the center accompanied by a friend and the friend’s mother. She tested positive in the pregnancy test and was then referred to a counselor to receive additional information about the services offered by the center. When speaking to the counselor she stated that she was afraid to tell her father that she was pregnant. While many of the young women in the center are apprehensive about these conversations the conversation is rarely as bad as is expected. In this the counselor suggested that BB call her parents and have them meet her at the center. Both of her parents arrived, heard the news and began to verbally assault the friend and the friend’s mother. The situation escalated to the point where the police were called. When they arrived permission had to be given to allow them into the counseling room with these individuals. The police were forced to ask BB’s parents to leave the room. They moved to the waiting room and once the friend and her mother left the counseling room continued the verbal assault. The police then asked the parents to leave the premises. The parents were then escorted to the parking lot and after they left the center could schedule BB for her ultrasound appointment. The staff at the center where concerned about BB’s home life so when she returned for her ultrasound the center the staff asked follow up questions to ensure that she and her baby were not in any physical danger from her parents. Currently the home situation is tense and her parents are not happy with the pregnancy but they are supporting her in her decisions.
For younger women who find themselves pregnant there is an increased risk of being exposed to either abuse or the potential for an unplanned pregnancy if there parents are not supportive. In these situations the center attempts to provide a neutral ground for the revelation about the pregnancy and then to provide the young women with information about other programs and living arrangements if they are necessary.
Therapies Offered
The center provides these women and their families with a form of behavior modification. Behavior modification is a psychological treatment that focuses on changing the patient’s or individual’s behavior with the use of rewards and punishments. Generally when patients are involved in the programs offered by the center it is because their past behavior has resulted in a situation that is out of their control. For the individuals that do not test positive for pregnancy the opportunity presents itself to use operant conditioning practices to assist the young lady from a similar scare by modifying their behavior.
The clients of the clinic experience a form of behavior modification while they are receiving counseling about their pregnancy. This is accomplished by focusing on the decisions that need to be made and the changes in lifestyle that need to be accomplished before the child is born. The clients are rewarded by the centers staff with praise and encouragement when a difficult decision has been made or a conscious effort by the client to change the ineffective behavior patterns. The center does not punish negative behavior in any specific manner because the condition of being pregnant tend to convince the clients that their behavior needs to change
Operant conditioning is a form of behavior modification that is currently being used in some areas for pregnancy prevention classes. In operant conditioning the consequences of a particular action are used as a reference for the subject to decide if the behavior is worth continuing. For instance if when a behavior is demonstrated it results in a reward the subject has been conditioned to except a positive outcome from the behavior and the behavior will continue. On the other hand if when a behavior is demonstrated it results in a punishment then the subject has been conditioned to except a negative outcome if the behavior is repeated and the subject learns not to demonstrate that particular behavior again. In the case of a pregnancy scare or actual pregnancy the medical condition itself is the negative reactions that are used to create the desired changes in the client’s behavior.
Researchers Suggestions
After working at the pregnancy center for several weeks the researcher believes that a method for increasing the effectiveness of the program is to maintain contact with the clients for several months past the birth of the baby. By increasing the interaction time to one year the progress that the clients made during their behavior therapy has a greater chance of maintaining long term results. When these two forms of therapy are combined it is possible to see increased results and positive changes in the client’s behavior patterns. By learning about the options available and increasing the range of the support networks the clients seen by the center become more aware of the range of options which lessens the feelings of fear and anxiety.
References
Hotz, Joseph, McElroy, Williams Susan and Sanders Seth G. (2005) Teenage Childbearing and Its Life Cycle Consequences: Exploiting a Natural Experiment. The Journal of Human Resources, Vol. 40, No 3, 683 – 715.
Raneri, Leslie G and Wiemann, Constance M. (2007) Social Ecological Predictors or Repeat Adolescent Pregnancy. Perspectives on Sexual and Reproductive Health, Vol 39 (1), 39-47.