Introduction
In the real world today, the issue of teenage pregnancy increasingly interferes with the social, personal, and economic lives of teenagers. Regarding the incidences of motherhood in adolescence, Latin America and the Caribbean have reached third globally. The region is ranked second in the adolescent fertility rate globally (Sanhueza et al., 2023). Some of the driving factors towards teenage pregnancies include social pressure, sexual violence, lack of information, and inadequate access to essential services. As such, the victims of teenage pregnancies are increasingly exposed to risks of mental health problems, including depression and intense stress. Thus, the focus of the CAPSTONE project is on teenage pregnancies.
Research objectives
- To demonstrate the impacts of the learning process in applied psychology
- To apply the competency, knowledge, and skills from the practicum experience in exploring the critical issue of teenage pregnancies in the real world.
- To demonstrate skills and knowledge of the program by creating a case study and a related treatment plan.
- To expand on the social work skills, knowledge, and competency by appropriately working out the case study.
- To develop relevant literature that informs the related aspects of the topic of teenage pregnancies.
Literature Review
Teenage pregnancy in the Caribbean and Latin America is a common issue. In Ecuador alone, a research study by Flores et al. (2020) shows that the region has the second-highest rate of adolescent pregnancy. About 19.6% of births in Ecuador are attributed to mothers below 20 years old (Bernardini et al., 2021). Some of the risks associated with teenage pregnancies are that the babies are likely to have low birth weight, preterm birth, and short stature. The study by Bernardini et al. (2021) confirms that teenagers born and living in poor households, those exposed to sexual abuse, and those not enrolled in schools are exposed to a greater risk of adolescent pregnancy.
According to the study by Nashtifani et al. (2021), the issue of pregnancy in adolescents is considered a critical issue worldwide amid medical and social consequences. The study agrees with the World Health Organization’s definition of the teenage pregnancy age bracket of 10-19 years. While pregnant teenagers are typically not ready for motherhood, the study underscores the need for empowerment. Empowerment experience develops a sense of independence, self-sufficiency, and enhanced interaction (Bealing, 2019). Pregnant teenagers require excellent self-care and self-management behaviors. The study further suggests empowering pregnant teenagers requires improved awareness and prenatal care for improved self-care behaviors. Thus, the cognitive-behavioral counseling approach is considered a viable option for offering routine care in the health system for pregnant teenagers. The education-oriented nature of cognitive-behavioral counseling adds to its viability in the case.
In a corresponding study by Boobpamala et al. (2019), cognitive-behavioral counseling is the solution to the early management of depression in pregnant teenagers. Referred to as the cognitive behavioral therapy, the approach helps counter the depressive symptoms. The study highlights various depressive symptoms associated with teenage pregnancy, including the lack of self-esteem, lack of support from spouse and family, drug use, domestic abuse, history of depression, and barriers in accessing health services. The CBT for early management of depressive symptoms promotes self-esteem, family and spouse support, and access to healthcare services (Nashtifani et al., 2021). Decreasing the severity of the depressive symptoms of teenage pregnancy calls for early management. The process requires collaborative work for physicians, nurses, psychologists, and the community, including the spouse, friends, and family (Bernardini et al., 2021).
Furthermore, teenage pregnancies create unresolved states of mind (Bernardini et al., 2021). Research by Madigan et al. (2015) was developed to establish effective control for the unresolved states of mind using Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). The study involved 43 socially at-risk pregnant adolescents with unresolved states of mind. The participants were randomly subjected to usual treatment through parenting classes or intervention groups. It was found that the TF-CBT, which is used in handling Posttraumatic stress disorder, could similarly be used to handle unresolved states of mind among pregnant teenagers.
Okatsau et al.’s (2022) study explores the CBT interventions for perinatal mental health. It recognizes that pregnancy, and especially teenage pregnancy, comes along with significant mental health issues, including depression. As such, the viability of the CBT intervention is under test. The study explored some significant CBT interventions, including interpersonal psychotherapy and psychoeducation. Despite the variations noted in the number of sessions and the timing for the CBT intervention, it was found that CBT significantly contributed to reducing depression compared to the usual perinatal care. Psychotherapy and psychoeducation are crucial in reducing anxiety and other related mental health concerns that come with pregnancy (Nashtifani et al., 2021).
Case Study
Case of Claire
Claire Audrey (Pseudonym) is a 17 -17-year-old teenage girl at Vere Technical High School in Hayes, Jamaica. She lives with her conservative parents in Hayes. Claire has been dating a peer for about two years now. Claire and the boyfriend had been intimate throughout their dating period. About two weeks ago, Claire took a pregnancy test, which came out positive. Claire kept everything for herself. Neither the boyfriend nor the parents knew about it. Claire was even hesitant to share with her best friend. At only 17 years old, Claire was not yet ready to be a mother.
Claire pays no meticulous attention to peer-group aspects of dressing, makeup, and hair. She appears to lose her concentration easily and is forgetful. Claire seems to be increasingly distracted. With a significant weight loss, her height remains appropriate for her age.
In the previous semester, Claire had been a highly accomplished student, with her academic grades above average. Her social successes are impressive, being part of the student council and captain of the badminton team. Based on the referral notes, Claire appears to have sustained good discipline, social behaviors, and academic well-being until several weeks ago. Last week, Claire served a 1 day of in-school Saturday detention for skipping classes and being caught in possession of cocaine. Focusing on the behaviors leading up to, during, and after the detention, several additional behavioral concerns were established.
Following the 1-day school detention, Claire caught the school counselor’s attention various times. On one of the occasions, a security guard walking around the school identified Claire as one of the several students who had been found using Cocaine under the football field bleachers, especially during the lunch breaks. The school janitor confirmed that she had suspected Claire’s involvement in drugs from odors during the 1-day detention. Since there was no definitive evidence, Claire was spared a suspension from the school. In subsequent lunch breaks, Claire was found. Her parents were invited to the school for a consultative meeting with the teacher and the counselor. The parents reported that Claire had had bad times even at home.
On another occasion, the same security guard reported to the Janitor that she had overheard Claire vomiting in the girl’s bathroom; however, Claire completely denied it and any other health problems. However, suspicions arose when Claire’s mother also reported to have overheard Claire vomiting in the bathroom before she went to school a few days ago, but “assumed that’s what girls do when they are 17, right?”
Claire remains in the class alone as other students spend time in the field, especially during break times. She misses the homework submission timeline and fails to complete some of her classwork. Claire has not attended the badminton practice for about two weeks despite being the captain. Her performance in last week’s continuous assessment test has significantly dropped compared to previous scores. Just a week ago, Claire broke up with the boyfriend. Further, she started distancing herself from her best friend. In class, she appears distracted and uneasy.
Following several concerns raised by the school counselor, Claire is referred to our independent practice for further help. With the parent’s consent, Claire is required to take a pregnancy test, which comes out positive. This comes as a great shock to both of her parents. It is depressing as Claire’s father pushes her out of their home. Having experienced a similar thing while she was in her teenage years, Claire’s mother promised Claire they would walk through the journey together. Claire’s mother finds her a place to stay (at her sister’s apartment, still in Hayes) for a week, and she engages with her father about the situation. As such, Claire requires significant counseling services to accept the pregnancy and stop the emerging related behaviors of social withdrawal and drug use.
Intervention/Treatment plan
| Problems |
| Teenage pregnancy leads to indulgence in the use of drugs during the school lunch breaks. Claire expresses social withdrawal, including breaking up with their boyfriend, distancing herself from her best friend, and avoiding interactions in sports. She has problems concentrating in class and is less motivated by academic work, considering the late submissions and missed classwork. |
| Goals for Change |
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| Theoretical Interventions |
| In Claire’s case, the theoretical intervention for teenage pregnancy involves Cognitive Behavioral Therapy (CBT). The CBT intervention works based on the connection between the individual’s thoughts, behaviors, and beliefs. Based on the fundamental CBT tenets, the CBT theory introduces coping skills and promotes better management of stressful situations (Beck, 2020). As such, using CBT allows the patients to replace the problematic thoughts, behaviors, and belief patterns with better and positive ones.
Through the CBT-based intervention, it becomes easier to comprehend the distorted thought patterns. In addition, it is key to understanding the primary dysfunctional behaviors that are associated with prenatal care. CBT helps talk about the worries and stress linked to teenage pregnancy. Through cognitive strengthening and reconstruction, the clients receive appropriate information to solve problems (Nakao et al., 2021). As such, it increases decision-making and independence in pregnancy while advocating for pregnancy empowerment. To test and ascertain the validity of their maladaptive cognitions on their ability to offer prenatal care, Claire would be involved as an active participant in the CBT. The aspects of pregnancy empowerment in the cases of teenage pregnancy where CBT applies involve the future image, self-esteem, self-efficacy, assurance, and support (Nashtifani et al., 2021). In the light of CBT, teenage pregnancy comes with a feeling of lack of support from others, including the parents and spouse. The feelings of powerlessness call for a dire need for comprehensive support and education to adjust to pregnancy (Bealing, 2019) emotionally. Thus, CBT intervention increases the feeling of receiving support and approval from the healthcare providers. For teenagers, pregnancy, childbirth, and motherhood are experienced as failures. However, it varies with the socio-cultural conditions. Thus, CBT helps shape a desirable future image for pregnant teenagers by helping them overcome their worries and stresses (Nakao et al., 2021). Thus, the CBT intervention would be ideal for our case. The client, Claire, will engage in individual counseling sessions for 10 weeks, with a single session every Wednesday. As such, the following CBT activities/approaches will be applied for Claire’s 10 weeks of sessions;
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| Outcome Measures of Change |
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Conclusion
Teenage pregnancy remains a highly prevalent issue. Claire’s case study reflects how her pregnancy at just 17 years influenced her academic, personal, and social life. She expressed social withdrawal, drug use behaviors, poor academic performance, and depressive symptoms such as lack of concentration. Cognitive Behavioral Therapy, which focuses on changing the negative patterns of thoughts, beliefs, and behaviors, was considered an ideal theoretical intervention for the case of teenage pregnancy. Thus, the teenage pregnancy topic/case study significantly impacts my practicum journey as a social work student. It imparted knowledge and skills of best practice in social work case management. Having developed a treatment plan for the client, Claire, it will be possible to offer the best intervention even for future clients with different needs. From my analysis of the case study, including the client’s identifying information and presenting concerns, I can easily understand a particular client’s needs, develop a diagnostic impression, and appropriate intervention in the social work practices on the practicum journey. The topic informed me of the challenges that could impair my subjects’ expected performance and behaviors during the practicum journey. The case study impacted my understanding of how theoretical interventions, particularly CBT, work in social work. Interestingly, the case greatly boosted my skills and knowledge of analyzing a person’s psychological needs in the light of applied psychology.
References
Bealing, J. (2019). Teen pregnancy: Tailoring a pregnancy app to the needs of pregnant adolescents (Doctoral dissertation, The University of Waikato). https://hdl.handle.net/10289/12932
Beck, J. S. (2020). Cognitive behavior therapy: Basics and beyond. Guilford Publications. https://books.google.com/books?hl=en&lr=&id=yb_nDwAAQBAJ&oi=fnd&pg=PP1&dq=cognitive+behavioral+therapy&ots=wjl_MACTTc&sig=boQRsYZ9NZMoyabZW7AX_9cPC9Y
Bernardini, S., Honton, G., Irizarry, L., Sanz, J., Castillo, E., Guevara, C., & Andrade, L. (2021). Preventing teen pregnancies and supporting pregnant teenagers in Ecuador. Field Exchange 66, 33. https://www.ennonline.net/fex/66/preventingteenpregnancies
Boobpamala, S., Kongvattananon, P., & Somprasert, C. (2019). Early management of depression in adolescent pregnancy: An integrative review. The Journal of Behavioral Science, 14(1), 97-113. https://www.researchgate.net/profile/Chomchuen-Somprasert-2/publication/333037956_Early_management_of_depression_in_adolescent_pregnancy_An_integrative_review/links/5cfa1b36299bf13a3843393d/Early-management-of-depression-in-adolescent-pregnancy-An-integrative-review.pdf
Espinel-Flores V, Gotsens M, Puig-Barrachina V, León-Gómez BB, Peralta A and Pérez G (2020) Trends in teenage motherhood in Ecuador: challenges and inequalities. International journal of public health, 65(9), 1647–1655. https://doi.org/10.1007/s00038-020-01517-w
Madigan, S., Vaillancourt, K., McKibbon, A., & Benoit, D. (2015). Trauma and traumatic loss in pregnant adolescents: the impact of Trauma-Focused Cognitive Behavior Therapy on maternal unresolved states of mind and Posttraumatic Stress Disorder. Attachment & Human Development, 17(2), 175-198. https://doi.org/10.1080/14616734.2015.1006386
Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial medicine, 15(1), 16. https://doi.org/10.1186/s13030-021-00219-w
Nashtifani, M. H., Tafazoli, M., Vaghee, S., Zarei, A. A., & Salarhaji, A. (2021). The Effect of Cognitive-Behavioral Counseling on the Empowerment of Pregnant Women Under 18 Years Old. Journal of Midwifery & Reproductive Health, 9(4). https://doi.org/10.22038/jmrh.2021.59040.1715
Okatsau, A., Aoyama, S., Yamaji, N., & Kataoka, Y. (2022). Cognitive behavioral therapy in perinatal mental health: An overview of systematic reviews. Japan Journal of Nursing Science, 19(4), e12501. https://doi.org/10.1111/jjns.12501
Sanhueza, A., Costa, J. C., Mújica, O. J., Carvajal-Velez, L., Caffe, S., Victora, C., & Barros, A. J. (2023). Trends and inequities in adolescent childbearing in Latin American and Caribbean countries across generations and over time: a population-based study. The Lancet Child & Adolescent Health, 7(6), 392-404. https://doi.org/10.1016/S2352-4642(23)00077-9
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