The MP group is a 10-week ‘class’ for mothers aged 15–21 and their children aged 0–6, that focuses on the following:
- strengthening the mother–child interaction
- improving parenting skills
- teaching self-care practices
- strengthening or establishing connections with the healthcare system and with social support networks.
All these activities are in the service of building secure attachment bonds between the mother and her young child. The programme is designed to teach participants to safely cope with their current stressful life circumstances and mental health symptoms – all of which may pose a risk to their parenting abilities and child's safety. The programme is also designed to teach how to parent responsively and sensitively, despite the aversive context. Each MP group session has a specific focus related to the topics described above. As mothers progress through the programme, they learn how to regulate their emotions well enough to feel safe and adequate in parenting. They learn to think clearly when under stress so that they can prevent, manage and recover from problems with anxiety, depression, addiction, anger, social isolation and dissociation when engaged in parenting.
MP also serves as a treatment engagement tool. The group aims to provide an environment for teenage mothers that is nurturing, supportive, encouraging and respectful. It teaches mothers about child development, provides psycho-educational information, parental guidance and ultimately gets mothers connected within the community. Moreover, the programme serves to build trust between mothers and health professionals, and is often the first stepping stone for the teenager to also accept psychiatric care or psychological counselling for their mental health or parenting condition. The goal of the MP group is often to connect the teenage mother with satisfactory resources within her community to allow for a comprehensive and holistic treatment setting for her and her infant.
MP recruits group participants either self-referred through the community or as referrals by local paediatricians, primary care doctors, social workers or other services providers. Many of the referrals come from healthcare providers who are concerned about the mother's parenting behaviours or the child's developing attachment bond and behavioural regulation.
In addition to 10 group sessions, each participant receives one individual counselling session midway through the programme to discuss subjective group experiences and satisfaction with the group process, and during this session an individualised follow-up treatment plan is formulated. Upon completion of the group, the individualised treatment plan is put in place through ‘warm hand-off’ community referrals. These community referrals, be it for medical, social or psychological care, or for developmental or behavioural child services, are facilitated by the MP group leaders who through the group process have familiarity with the teenage mothers' needs, as well as buy-in as a trusted resource for the teenager. Finally, the MP group participation also enhances the teenagers' circle of social support through befriending with other group members, which in turn furthers the teenage mothers' well-being.14,15
Conceptually, the MP group curriculum identifies five areas as important therapeutic targets, and these are illustrated in . These areas are:
- psycho-education about attachment-based parenting
- support for positive parenting by practising sensitive mother–child interaction during supported separations and reunions
- education about and practice of healthy self-care and coping skills
- enhancement of the mothers' social support networks
- development and implementation of individualised follow-up care based on a careful individualised needs assessment.
The MP groups were implemented in 2008, yet systematic data collection on teenage participants started from 2009. We have now gathered some preliminary data on the teenagers who have ‘graduated’ from the MP group programme in 2009/2010. We have demographic data on 23 teenage mothers with an average age of 19.6 years (SD = 1.36), ranging from 16 to 21 years. The teenage mothers had on average one or two children (M = 1.17, SD = 0.39), and the average age of their child was around 16 months, ranging from newborns to 3-year olds. Graduates were ethnically diverse yet predominantly minority teenage mothers (25% Caucasian, 65% African American, 10% biracial), had little education (39% less than high school, 33% high school completion, 28% some college), mostly single (5% married, 14% living with the birth father, 81% single) and of low income (42% under $5000, 32% $5000–10 000; and 26% above $10 000). The participating teenage mothers had experienced on average around five traumatic events at the beginning of the group (M = 5.48, SD = 2.81), ranging from 1 to 11, and these events were predominantly serious money problems (72%), having someone close die (72%), themselves or a family member being sent to jail (50%), having someone close die suddenly (48%), being physically attacked by a boyfriend (40%) or being neglected (43%) or emotionally abused (40%) by a parent. Not surprisingly, almost half of the teenagers (10/24) met the criteria for PTSD, and half (13/24) met criteria for major depressive disorder (MDD) at the beginning of the group. Although the exposure to trauma was ongoing even during the MP intervention, and teenage mothers experienced on average more than two traumatic events (M = 2.68; SD = 2.14) during group participation, the experience of being connected to the MP programme decreased rates of psychiatric diagnoses when reassessed after the 10-week curriculum. Post-group only one teenager met still criteria for PTSD (down from 10), and only seven met criteria for MDD (down from 13) after the group. This decrease in diagnostic classifications is also reflected in symptom reductions from pre- to post-MP group assessment; both PTSD and MDD symptoms decreased significantly across the intervention (PTSD: pre MP mean = 6.96, SD = 4.35 to post MP mean = 4.87, SD = 2.97, t(23) = 2.406, P < 0.05, see ; MDD: pre MP mean = 82.24, SD = 30.31 to post MP mean = 68.08, SD = 20.93, t(24) = 2.923, P < 0.01; see ). In addition to mental health improvements in the face of ongoing trauma, the teenage mothers also self-rated as less guilty and ashamed regarding their own parenting skill after the MP group (pre MP mean = 9.12, SD = 4.85 to post MP mean = 7.48, SD = 3.07, t(24) = 2.056, P = 0.05).
PTSD symptoms from pre to post MP group
MDD symptoms from pre to post MP Group
These results are promising, yet limited by design and statistical issues. First, the sample size is small and a control condition is lacking. Thus, we cannot exclude that the teenage mothers improved in psychopathology across the 10-weeks just because of unspecific factors, such as attention by research staff or by chance alone. However, this first round of MP groups aimed primarily to test feasibility and acceptance among the target population, and both were confirmed. In the next iterations of this model, we will implement a more stringent research design, and use randomisation and a control condition. Second, the outcome measures are primarily self-rating scales, which gives room for reporting biases. For example, because the parenting skills improvement is assessed by self-report alone, the results may be due to the teenage parent's enhanced self-esteem regarding parenting as opposed to true improvements in sensitivity during observable mother–child interactions. Subsequent data analyses will rely more on objectively coded parent–child interactions and clinician-derived changes in psychiatric symptomatology. However, despite the limitations in sample size, lack of randomisation and of control group design, we believe, that these results show promise regarding the feasibility and effectiveness of this integrated, primary-care-based approach for teenage mothers with young children.