Sources of Stress and Support and Maternal Resources of Homeless Teenage Mothers

Maternal self-efficacy and emotional well-being in Chilean adolescent mothers: the relationship with their children's social-emotional development

Background

Low maternal self-efficacy and high levels of anxiety, depression, and stress can be triggered in adolescent mothers due to an incomplete development process that makes them physically or psychologically unprepared for the responsibilities of motherhood and parenting. These factors may be linked to difficulties with their children's social-emotional development. The present study aims to: (a) analyze the relationship between maternal self-efficacy and stress, depression, and anxiety levels in low-income adolescent mothers; (b) examine the relationship between maternal self-efficacy and well-being with children's social-emotional development; and (c) describe the effects of maternal self-efficacy on children's social-emotional development, mediated by maternal well-being.

Methods

A sample of 79 dyads comprising low-income Chilean adolescent mothers aged from 15 to 21 years old (M = 19.1, SD = 1.66) and their children aged 10 to 24 months (M = 15.5, SD = 4.2) participated in this research. A set of psychometric scales was used to measure maternal self-efficacy (Parental Evaluation Scale, EEP), the mothers' anxiety and depression (Hospital Anxiety and Depression Scale, HADS), maternal stress (Parental Stress Scale, PSS), and the children's social-emotional development (Ages and Stages Questionnaire Socio-emotional, ASQ-SE). Bivariate analyses and mediation models were employed to estimate and test the relevant relationships.

Results

A bivariate analysis showed that maternal self-efficacy was negatively related to the mother's anxiety, depression, and stress. Moreover, there was a significant relationship between maternal self-efficacy and maternal stress, and children's self-regulation and social-emotional development. Maternal self-efficacy, mediated by maternal anxiety, depression, and stress scores, had a significant effect on the development of children's self-regulation.

Conclusions

The results confirm the importance of adolescent mothers' emotional well-being and maternal self- efficacy with respect to their children's social-emotional development. This makes it necessary to have detailed information about how emotional and self-perception status influences a mother's role in the development of her children.

Children's early school attendance and stability as a mechanism through which homelessness is associated with academic achievement

Unfortunately, family homelessness is a crisis in the United States. The majority of families experiencing homelessness are headed by single mothers and half of children who experience homelessness are less than five years of age. In the current study, we investigated whether children's school attendance and stability mediated the association between early experiences of homelessness (in infancy and toddlerhood) with children's school performance on standardized assessments of math and English language arts administered in the spring of third grade in a sample of children of young mothers. We used a person-centered analytic technique (i.e., repeated measures latent class analysis) to identify three classes of children's patterns of school attendance and stability from kindergarten through third grade that consisted of (a) High Absenteeism, (b) Decreasing Absenteeism, and (c) Low Absenteeism classes. Early experiences of homelessness were directly and indirectly associated with math, but not English language arts scores, through the three identified classes. The results of the current study have important implications for young children who experience homelessness and suggest promoting school attendance as one avenue to support academic achievement. In addition, supporting families and children early (i.e., before they begin pre-kindergarten) will be key in ensuring that young children who experience homelessness are successful in educational environments.

UNDERSTANDING PARENTING STRESS AND CHILDREN'S BEHAVIOR PROBLEMS AMONG HOMELESS, SUBSTANCE-ABUSING MOTHERS

This article tested a model of parenting stress as a mediator between maternal depressive symptoms, emotion regulation, and child behavior problems using a sample of homeless, substance-abusing mothers. Participants were 119 homeless mothers (ages 18-24 years) and their young children (ages 0-6 years). Mothers responded to questions about their depressive symptoms, emotion regulation, parenting stress, and child behavior problems. A path analysis showed that maternal depressive symptoms were positively associated with child behavior problems through increased parenting stress whereas maternal cognitive reappraisal was negatively associated with child behavior problems through decreased parenting stress. Moreover, maternal expressive suppression was negatively related to child externalizing problems. Findings support the parenting stress theory and highlight maternal parenting stress as a mechanism associated with homeless children's mental health risk. This study has significant implications for understanding the parenting processes underlying child's resilience in the context of homelessness and maternal substance use.

Nursing Child Assessment Satellite Training Parent-Child Interaction Scales: Comparing American and Canadian Normative and High-Risk Samples

PURPOSE

Many nurses rely on the American Nursing Child Assessment Satellite Training (NCAST) Parent-Child Interaction (PCI) Teaching and Feeding Scales to identify and target interventions for families affected by severe/chronic stressors (e.g. postpartum depression (PPD), intimate partner violence (IPV), low-income). However, the NCAST Database that provides normative data for comparisons may not apply to Canadian families. The purpose of this study was to compare NCAST PCI scores in Canadian and American samples and to assess the reliability of the NCAST PCI Scales in Canadian samples.

METHODS

This secondary analysis employed independent samples t-tests (p < 0.005) to compare PCI between the American NCAST Database and Canadian high-risk (families with PPD, exposure to IPV or low-income) and community samples. Cronbach's alphas were calculated for the Canadian and American samples.

RESULTS

In both American and Canadian samples, belonging to a high-risk population reduced parents' abilities to engage in sensitive and responsive caregiving (i.e. healthy serve and return relationships) as measured by the PCI Scales. NCAST Database mothers were more effective at executing caregiving responsibilities during PCI compared to the Canadian community sample, while infants belonging to the Canadian community sample provided clearer cues to caregivers during PCI compared to those of the NCAST Database. Internal consistency coefficients for the Canadian samples were generally acceptable.

CONCLUSIONS

The NCAST Database can be reliably used for assessing PCI in normative and high-risk Canadian families.

PRACTICAL IMPLICATIONS

Canadian nurses can be assured that the PCI Scales adequately identify risks and can help target interventions to promote optimal parent-child relationships and ultimately child development.

Stress reduction in a high stress population: A service-learning project

Psychology students delivered stress and coping workshops to homeless adolescent mothers as part of a college service-learning project. In this vulnerable and underserved population, stress reduction is critical. Service-learning was used as an avenue to enhance student learning and growth while helping meet this need in our community. The psychology students developed deeper learning, professional skills, and social awareness. The adolescent mothers developed stress reduction skills that they were able to successfully implement. Challenges and recommendations for the implementation of similar service-learning projects are discussed.

Characterizing Social Determinants of Health for Adolescent Mothers during the Prenatal and Postpartum Periods

PURPOSE

Significant racial disparities and continuing poor birth outcomes make adolescent pregnancy a significant public health concern in the United States despite declining pregnancy rates. Social determinants of health are associated with increased likelihood of pregnancy and poor maternal and child health outcomes. This study aims to characterize specific elements of social determinants of health in a cohort of predominantly Latina adolescent mothers.

METHODS

Between February 2007 and August 2008, 106 pregnant adolescents participated in a study with assessments at 20 to 24 weeks of gestation, and at 3 and 6 months postpartum. Survey questions addressed residential mobility, financial support and childcare, and perceived need for and use of community resources. Comparative analysis assessed differences between adolescents by age (<16 vs. ≥16 years old) and ethnicity (Latina vs. non-Latina).

FINDINGS

Adolescent mothers experienced high rates of residential mobility, with 59.4% moving at least once in the year before their prenatal survey. Participants relied primarily on public aid (94-96%) and their parents (81-85%) for financial support. Latina participants were more likely than non-Latinas to rely on public aid. Although many participants reported needing financial support and housing, few used available services. Younger adolescents relied less often on the father of the baby for support than older adolescents.

CONCLUSIONS

Adolescent mothers' high rates of residential mobility and increasing reliance on public assistance highlight resource gaps that potentially put them and their children at risk for poor outcomes. Targeted efforts to augment systemic support in these domains are a critical component of addressing health disparities for this population.

Social Support and Psychosocial Well-being Among Low-Income, Adolescent, African American, First-Time Mothers

AIMS

The aims of this study are to describe for single, low-income, adolescent, African American new mothers how (1) primary sources of social support changed over time, (2) the level of social support (emotional, informational, tangible, and problematic) from these primary sources changed over time, and (3) social support from the primary supporter was associated with mothers' psychosocial well-being (self-esteem and loneliness) over time.

DESIGN

A secondary analysis was conducted of data from a previous social support intervention study.

SAMPLE

The sample consisted of 35 single, low-income, adolescent (mean [SD] age, 18.3 [1.7] years), African American new mothers.

METHODS

Mothers completed social support, self-esteem, and loneliness instruments at 1 and 6 weeks and 3 and 6 months postpartum.

RESULTS

Most mothers (64.7%) had changes in their primary social support provider during the first 6 months postpartum. The combination of the adolescent's mother and boyfriend provided the highest level of support, no matter the type, relative to any other source of support. At every time point, positive correlations were found between emotional support and self-esteem and between problematic support and loneliness.

CONCLUSION

Single, low-income, African American, adolescent new mothers are at risk for not having a consistent source of support, which may lead to lower self-esteem and greater loneliness.

IMPLICATIONS

Clinical nurse specialists could facilitate care guidelines for these new mothers to identify their sources of support at each home visit and advocate for the adolescent's mother and boyfriend to work together to provide support. Bolstering the mothers' natural sources of support can potentially improve self-esteem and reduce loneliness. Improvement in these sources of support could prevent a decline in the mothers' psychosocial well-being. Development and testing support interventions are advocated; findings could guide clinical nurse specialists in addressing these new mothers' needs.

Physical and Psychological Aggression towards a Child among Homeless, Doubled-up, and Other Low-income Families

This study examines the extent of adverse parenting behaviors among low-income families with children and determines whether housing instability, measured by homelessness and doubling up with relatives or friends due to economic hardship, increases the likelihood of physical and psychological aggression towards a child, after considering the contribution of other relevant characteristics. Using data from 3 waves of the Fragile Families and Child Wellbeing Study, this study followed 2,332 low-income children in 20 large U.S. cities. Multivariate analyses involved logistic regression with generalized estimating equations. Adverse parenting behaviors were common among all low-income families regardless of their having experienced housing instability. Nonetheless, mothers with a homeless or doubled-up episode reported higher rates of physically and psychologically aggressive behaviors towards a child compared to the housed group. Having a homeless episode was significantly associated with a greater likelihood of reporting a high level of physical aggression towards a child. Child's behavioral issues, maternal depression, and parental stress also contributed to adverse parenting behaviors. Findings suggest that housing instability can be a marker of adverse parenting behaviors and service professionals need to respond to parenting needs as well as housing needs for families in unstable housing. Areas of future research were discussed.

Everyone deserves a second chance: a decade of supports for teenage mothers

Georgia had the third highest 2010 repeat teenage birth rate in the United States and has had one of the worst rates for years. Since 2001, Georgia's Second Chance Home Network, administered by the Georgia Campaign for Adolescent Power and Potential, has provided housing and support to parenting teenagers--almost two-thirds of whom were in custody of and referred by Georgia's Department of Children and Family Services--to help them become nurturing and self-sufficient parents, to avoid repeat teenage pregnancies, and to promote healthy development of their children. Data were collected from each resident at intake, discharge, and three follow-up points at three, 12, and 24 months after discharge. Evaluation has consistently revealed improvements in several key outcomes, including education, housing, income, self-sufficiency, parenting, repeat pregnancy, and child outcomes. The 2012 evaluation revealed benefits in all these areas and found that those who stayed longer demonstrated better outcomes, especially related to the core outcomes of educational status, employment, and stable residence. Methods and findings about these outcomes are featured in this article.

Tailoring clinical services to address the unique needs of adolescents from the pregnancy test to parenthood

Clinicians across disciplines and practice settings are likely to encounter adolescents who are at risk for a pregnancy. In 2010, 34.2/1000 15-19-year-old teens had a live birth in the United States, many more will seek care for a pregnancy scare or options counseling. Teen mothers are also at risk for a second or higher-order pregnancy during adolescence. This paper provides clinicians with adolescent-friendly clinical and counseling strategies for pregnancy prevention, pre- and post-pregnancy test counseling, pregnancy-related care, and a review of the developmental challenges encountered by teens in the transition to parenthood. Clinicians are in a better position to approach the developmental, health and mental health needs of adolescents related to pregnancy if they understand and appreciate the obstacles adolescents may face negotiating the healthcare system. In addition, when clinical services are specially tailored to the needs of the adolescent, fewer opportunities will be lost to prevent unintended pregnancies, assist teens into timely prenatal services, and improve outcomes for their pregnancies and the transition to parenthood.

The school readiness of children born to low-income, adolescent Latinas in Miami

Although studies show teenage parenting and low socioeconomic status predict poor child academic performance, limited research has examined relations between teen parenting and children's school readiness within low-income Latina mothers. In the context of the Miami School Readiness Project, low-income preschoolers (N = 3,023) attending subsidized child-care programs were assessed on cognitive, language, and fine motor skills, and parents and teachers reported on children's social skills and behavior concerns. Maternal teenage status at time of birth, maternal education, child attachment, child immigrant generational status, language, and other demographic variables were explored, as they uniquely and interactively predicted children's school readiness. Teenage parenting among low-income Latinas in this sample was less frequent (15%) than national estimates and more common among mothers born in the United States. Teen parenting was negatively associated with child cognitive and language competence at age 4, controlling for background variables. Maternal receipt of a high school diploma contributed additively, rather than interactively, to child outcomes. Parent-reported strong child attachment served as a buffer against the negative effects of teen parent status on child outcomes. Implications for intervention are discussed.

A comparative assessment of early adult life status of graduates of the North Carolina adolescent parenting program

PROBLEM

What is the comparative impact of a second pregnancy prevention program for teen mothers on those who graduate from the program compared with a sample of young mothers of similar age and social circumstances who did not participate in the program?

METHODS

Fifteen program graduates and 20 nonprogram cohorts were surveyed regarding a range of life domains.

FINDINGS

Data indicated that program graduates were on a more positive life course: greater primary responsibility for housing and utilities, greater higher education enrollment, more job stability, and greater focus on career goals.

CONCLUSION

The differences demonstrate the value of programs designed to assist teen mothers through the challenges of parenting and their own adolescent development. Teen mothers who received these resources became more capable, happier, and confident, which in turn will make them better parents and more empowered to pursue their own personal development.

Adolescent mothers' experiences of caring for their children while homeless

The purpose of this descriptive phenomenological study was to describe homeless adolescent mothers' experiences of caring for their children while living in a shelter. Eight homeless adolescent mothers participated in the study. Data were analyzed using Colaizzi [Colaizzi, P. (1978). Psychological research as the phenomenologist views it. In R. S. Valle & M. King (Eds.) Existential Foundations of Psychology (chapter 3). New York, NY: Oxford University Press]. Five themes were generated: (a) tough and troubling times, (b) acting out, (c) wishing it undone, (d) hostile encounters, and (e) steering clear. Nurses working with homeless families may help these young mothers cope with the demands of shelter living while keeping in mind that distinctive support needs may arise during different times of the homeless experience.

Attachment patterns of homeless youth: Choices of stress and confusion

This commentary explores the reproductive strategies and attachment patterns among homeless youths. Del Giudice's integrated evolutionary model is applied to a homeless youth population that must function in ecological settings of constant high risk and stress. Different reproductive needs result in different patterns of high-risk behaviors. Intervention considering the sex differences, life history, and early caregiver–child relationships is suggested.

Testing a bioecological model to examine social support in postpartum adolescents

PURPOSE

The purpose was twofold and included examining a bioecological model as a framework to describe social support in postpartum adolescents. The second purpose was to determine the relationship between a comprehensive view of the context of social support and symptoms of depression.

DESIGN

Cross-sectional design with convenience sampling (n=85) of adolescents at 4-6 weeks postpartum, recruited from two community hospitals.

METHODS

Approval was received from the university's IRB (institutional review board), each recruitment site, the adolescent mothers, and their parents or guardians. Data were collected by a research assistant during home visits using a battery of self-report instruments to measure macro, meso, and microsystems of social support. Demographics, exposure to community violence (macrosystem), social support, social network (mesosystem), and perceived stress, mastery, and self-esteem (microsystem) were predictor variables. Depressive symptoms were measured by using the Center for Epidemiologic Studies of Depression (CES-D) Scale.

FINDINGS

Variables from each system were significant predictors of depressive symptoms but perceived stress was the strongest predictor. Many postpartum adolescents reported that they had been victims of violence. Significant symptoms of depression were identified in 37% of the postpartum adolescents.

CONCLUSIONS

Context is important to consider in comparing international studies of social support. Researchers and clinicians should investigate variables associated with the low incidence of treatment for depressive symptoms in postpartum adolescents.

CLINICAL RELEVANCE

Feelings of high self-esteem and mastery should be fostered in nursing interventions with postpartum adolescents and routine screening for symptoms of depression should be considered in relevant healthcare settings.