Working with teens in Schools: Moving From a Pathology to a Competency Model

Jan Wiedman, MSW, RSW, ACSW, Clinical Social Worker, Adolescent at Risk Program
BMaureen Johnston, B Ed., Jr. High Teacher/School Counselor Lionel Dibden, MBBCh, FRCP (C), Program Director, Adolescent at Risk Program

Introduction

Edmonton is located in the Capital Health Region of Alberta. The region has a population of just over 750,000 people. There are about 53,000 people aged 10 - 14 years and 50,000 aged 15 - 19 years. The school system has separate (Catholic) and public school boards, which have a mixture of 'free standing' Junior High Schools (grades 7 to 9 inclusive) and schools where these grades are attached to elementary schools.

The Group Awareness Program (GAP) started as a collaborative community project involving the personnel of the Adolescent at Risk Program of the Misericordia Community Hospital, Caritas Health Group, and the counselor from each of two local Junior High Schools. Although differences existed in the two initial locations, a synopsis description of what the Group Awareness Program has become, follows.

Program Description

The Group Awareness Program (GAP) is designed to offer participants an opportunity to experience personal growth through a group process. Within a safe and healthy environment, participants are encouraged to attain their unique potential, and to increase their capacity to experience successes in their lives.

The GAP began operating at one Junior High School at the beginning of 1995 and was initially offered to Grade 9 students. At the beginning of the next school year, it was decided to offer a year seven and year eight group. A mixed grade level group was commenced at another Junior High School in the Fall of 1995.

Driving the need for the GAP was a number of students requiring psycho-emotional assistance who were not accessing this service in the community. Youth who attended the GAP were experiencing difficulties such as depression, family violence, poverty, suicidal ideation, body image issues, low self esteem, separation and loss, eating disorders, relationship difficulties, limited problem solving abilities, sexual assault, at risk for school failure or dropping out, parent-teen conflict, etc; etc.

The group is held weekly for 60 to 90 minute sessions during class time. The preference is for the group to be co-led by a school counselor and 2 trained group psychotherapists (one male and one female). The primary purpose of the therapists in group is to ensure safety for all members; to role model healthy and efficacious behavior; to nurture; to support; to challenge distortions; to be the targets of the transference of group members; and to offer interpretations aimed at providing group members with insights into their worlds and behavior.

Adolescent Development and Adolescent health care

The philosophy of Adolescent Healthcare requires an integrative approach to healthcare, health promotion and negative outcome prevention, which is consistent with the successful completion of the main tasks of adolescent development, namely: becoming a complete, competent adult with a clear sense of one's own identity and values and being comfortable pursuing an intimate sexual relationship of one's own choosing in an independent fashion.

Adolescent Healthcare is seen as an integrative disciplines which has as its foundation the principle that physical, mental, emotional, spiritual and social health are inseparable. There is considerable advantage to having pediatricians specializing in this discipline as group therapists as they are able, on a weekly basis, to monitor all dimensions of the health of the adolescents they are serving, and to intervene medically when necessary.

Why Have Group and Why in a School?

It is an efficient and effective use of resources to see several students with similar issues at one time.

Group is the preferred modality when working with adolescents as the peer group is all-important at this time of development.

As the school counselor is significantly involved in identifying students with difficulties, having the group in the school allows for ongoing support outside of the group. Since many students present with similar issues, it is a more efficacious use of the counselor's time to deal with them in a group.

It is believed that the school environment, and more specifically the peer environment, offer a greater likelihood that positive changes in participants' day-to-day functioning resulting from the group can be consolidated.

It is also believed that locating the group in the school ensures that potential barriers between the school and community service providers can be avoided through direct access.

School is a place where adolescents gather naturally. Holding group in school depathologizes presenting problems and allows more opportunity to tap into the natural resilience and inherent competencies of these students.

Prerequisites for Group Membership

In order for students to benefit from the group experience, participants need to have a "core of health"; they need to have the capacity to develop insight; they need to be able to function in a group setting; they need to have the capacity for reciprocity; and they need to be able to maintain group confidentiality.

Goals of the GAP

To provide a safe, supportive and nurturing environment where participants are allowed to explore their difficulties and those of their peers and generate insight.

To provide participants with the opportunity to observe and practice healthy, pro-social interpersonal interactions.

To provide alternatives to stereotyped roles and behavior, which may be negatively impacting identity formation.

To assist participants in establishing healthy personal boundaries.

Desired outcomes of the GAP

Improved physical, mental, emotional, social and spiritual health, including appropriate modulation of affect.

Improved school attendance and academic performance.

Increased ability to cope.

Increased ability to trust others appropriately.

A Teacher/Counselor's Perspective on the GAP and its Efficacy

Because at schools teachers are dealing with the "whole" child, staff needs to be cognizant that the adolescent does not attend school in a vacuum. The student brings with him or her the outside world he or she lives in. Outside of school, students engage in social and familial relationships that are a part of their world. Formal schooling which occurs for 5 1/2 hours a day represents only a portion of a student's existence. Therefore, there is an overlap of the social and familial aspects of a student's world with the school's educational goals for the student.

On occasion, some students experiencing trauma in their lives may need to temporarily set aside our/their educational goals to allow them to recover from and work out the trauma without the added stress of attending and performing adequately at school. To experience success at school, students must be in class; follow the class rules; focus on class material; and put in the required effort to complete required assigned tasks.

For some students, what goes on for them both inside and outside of school interferes with their chances of experiencing success at school. Teachers can help spot some of these students, hopefully early on before problems become entrenched, by being vigilant to the following:

Warning Signs>

Attendance
sporadic due to crises which they "must attend to"suspensions for inability to follow school routines

Hallway
out of class time student requests to leave class to "sort out" situations with friends
inability to follow staff requests to be in class to do the work necessary for success in school
leaving the school building, after signing out or not, to continue to solve or work on situations with which they feel powerless to cope
numerable "trauma calls" to the school counselor to intervene in their problem situations

Home the family indicates that there are medical, social, mental and/or emotional problems at home
the family indicates that the student is reacting to past or ongoing trauma

Sometimes, these warning signs indicate a picture where the student is experiencing severe problems and is in dire straits. For some, school may cease to be the best place for them unless and until there is intervention to alleviate the crisis and support them at school. Alternate school placement, intense therapy, and/or alternative living arrangements may be options to consider in these situations.

For students with difficulties who are able to continue on at school, group therapy at school may be the option of choice.

The GAP

Many group members have serious problems in their lives. Their problems are not remote. Their problems affect how they perform and behave in the classroom. In many cases, their problems have been longstanding and perhaps chronic.

Crises can lead to change. The GAP allows members to learn that they are not alone; that there are credential group leaders who will guide the group in its work; and that there are some things that they are able to change and some they are not. The leaders will ensure the group members' protection as far as is possible. What is said in-group is confidential, except when the member may be in danger or when a leader is subpoenaed to court on a matter relating to the member.

We want to empower members to capitalize on the strengths, innate capacities and resilience that they possess to become strong and successful adults.

In the classroom, group members are to follow the class rules and instructions like any other student. Group members require compassionate understanding, not sympathy. They are often angry and fragile individuals who have little regard for or faith in the "big people" in their lives. However, they are still accountable for their behavior. Some of their families are willing to keep the school informed of crises at home - others are not.

Group members are best supported by not "buying into" any manipulation strategies. They may use manipulation or "acting out" effectively as a method of coping in their dysfunctional or stress-filled lives. As teachers, we must try not to personalize the behavior and understand that it often has nothing to do with us but everything to do with what is going on in their lives.

Sometimes, group members have an unrealistic image of the "importance" of certain events or situations in their lives. This may be due to the fact that they see the world through distorted lenses. The intention of the leaders is to assist members to see the world as it really is and to operate in a healthier, more grounded manner.

Frequently, things are brought to the surface in-group and there may be "spill over" into the hallways and classrooms. This is normal and to be expected. Teacher feedback as to how group members are coping is helpful.

By and large, group members are young persons who need to be nurtured and encouraged by the healthy role models in their lives. Saying things like "your smile brightens my day"; "when I see you happy, I know that this is going to be a great class"; "thanks for helping me with ...."; etc., provides the kind of recognition, acknowledgement and affirmation which these students require even more than other students.

Always mindful of the confidentiality of group, attempts are made to keep teachers informed of situations that require careful vigilance, or successes to be celebrated. Teachers make known to the GAP leaders those classroom situations that assist group members to maximize their potential.

Initial GAP Evaluation

The importance of the ongoing evaluation of the GAP is recognized. Over the last academic year (Sept/97 to June/98), an attempt was made to evaluate the efficacy of the GAP. The instrument used was THE PIERS - HARRIS CHILDREN'S SELF - CONCEPT SCALE, developed in 1969 and published by Western Psychological Services, Los Angeles, CA.

The Scale was administered to all group members at the initial group session in Sept/97 and the final group session in June/98. Unfortunately, there were only 5 original group members who completed the Scale in June/98. The results are depicted below in Table 1. As Table 1 reveals, there was a positive change for the 5 students over the period of time from the beginning to the end of group on the variables measured.

This attempt to evaluate the GAP was a preliminary one. For the next academic year (i.e. Sept/98 to June/99), the GAP will be evaluated at all 5 school sites where it is operating. The instrument that will be used for this evaluation attempt will be THE BASC (SELF - REPORT, TEACHER RATING SCALES AND PARENT REPORTING SCALES) developed in 1992 and published by American Guidance Service, Inc. in Circle Pines, MN.

Conclusion

The philosophical perspective of the resilience and competence of youth, the pragmatic consideration of fiscal efficiency, the 'goodness of fit' of a peer group modality and adolescents and the provision of service by a healthcare/education team, in a school location, seems to have come together as a effective intervention for some youth in the form of the Group Awareness program.

Further evaluation, in a more controlled form, will hopefully show effectiveness, which can be stated with greater conviction than is presently possible.

For Information: Dr. Lionel Dibden
8770 , 165 st, #165
Edmonton AB T5R 2R8
Tel: (403) 930-5919
Fax: (403) 930-5669