Counseling Schedule: Early Adolescence

2. Counseling Schedule: Early Adolescence VISIT INTRODUCE • Family Time Together • Peer Relationships • Support System • Staying Safe • Teen Mental Health • Conflict Resolution Skills • Healthy Dating • Gaining Independence 11 to 14 YEARS

3. Early Adolescence • Independence is an overarching characteristic of the early teen years • Becoming independent means being more responsible for one’s own safety • Help teens stay safe by teaching them how to avoid violence through good communication skills • Effective communication is the common thread for the Connected Kids early adolescence counseling

4. Early Adolescence • Talk with teens and parents about activities that help families stay connected; many teens areunsureabout family relationships1 • Parents influence their teen children; discuss parental use of alcohol, tobacco, and other drugs • Involving adults from outside the family has a positive effect on teen development2 • Encourage teens to get involved in their communities; it is one of the best ways to help them stay safe3

5. Early Adolescence • Teens with friends engaged in risky behaviors are more likely to imitate these behaviors4 • Conversely, friends involved in constructive, prosocial activities encourage healthy and safe behaviors • Teen dating violence affects approximately 1 in 8 high school students. Discuss healthy dating with both teens and their parents5 • Youth who have a variety of ways to solve conflicts are less likely to be hurt in a fight or arrested6

6. F I S T S Fighting Injuries Sex Threats Self-defense Use this mnemonic as the basis for assessing an adolescent’s risk for involvement in violence. See the Connected Kids Clinical Guide for more details. Early Adolescence

7. Early Adolescence Counseling for Parents Address parents’ concerns about safety while still helping them encourage their teen’s independence What do you think of your teenager’s friends? How are you monitoring your teenager? How do you negotiate rules of behavior? What kind of activities does your child enjoy? What most concerns you about your teenager’s safety?

8. Early Adolescence Counseling for Youth With independence comes the responsibility for staying safe. Whom do you turn to for advice and encouragement? Whom do you go to for help if you’re having trouble in your relationship? What do you do to stay safe? What after-school activities are you involved with? What do you and your friends like to do?

9. Early Adolescence Brochures

10. Talking With Your Teen: Tips for Parents Early Adolescence • Describes typical teen behaviors and feelings and emphasizes parent-child communication as independence increases • Teaches parents how to: • establish reasonable limits • encourage safety as independence increases

11. How to Use this Tool • Initiate discussion at puberty by asking,“I’m sure there are many other changes going on that you can’t see with your eyes, aren’t there?” • Speak with parents regarding concerns about their child’s puberty Helpful Hints! • Having both teens and parents read this brochure may encourage better communication between parent and child • Ask parents to think about their own adolescence and how they behaved and coped at this age

12. Staying Cool When Things Heat Up Early Adolescence • Encourages teens to think about ways to resolve conflicts other than fighting • Discusses the role bystanders play in promoting violent behavior

13. How to Use this Tool • Use different approaches based on violence history: • “You’re very healthy, but I’m worried about all the fights you’re getting into.” • “Your exam looks good and I’m also glad to hear that you haven’t been getting into a lot of fights.” Helpful Hints! • Some clinicians leave this brochure in the waiting room for patients to read beforehand • It may help to let patients know that this information came from other teenagers.

14. Expect Respect: Healthy Relationships Early Adolescence • Discusses healthy relationships and ways to recognize and prevent partner violence • Teens are still experimenting with intimate relationships and may be more open to improving the quality of their relationships • While designed for all teenagers, it had the most resonance with young female teens in focus groups.

15. How to Use this Tool • Introduce when teens show an interest in relationships, dating, and sexual behavior • Discuss healthy relationships along with physical concerns such as sexually transmitted diseases • Can be used with sex education courses in schools Helpful Hints! Today we have discussed some of the physical issues of intimate relationships, but the emotional issues are just as important. At the end of an exam, say:

16. Teen Dating Violence: Tips for Parents Early Adolescence • Discusses parental response when partner abuse is suspected • The main concern for parents is their child’s happiness and welfare, not pointing out what is wrong with the abusive partner

17. How to Use this Tool • Encourage parents to: • empathize with what their child is experiencing • support their child in finding and maintaining non-abusive, healthy relationships Helpful Hint! Give this brochure to parents at the same time Expect Respect: Healthy Relationships is given to teenagers

18. Counseling Schedule: Middle Adolescence VISIT INTRODUCE 15 – 17 YEARS • Plans for the Future • Firearms and Suicide • Depression • Resiliency

19. Middle Adolescence • There is a direct link between assets and the risk for violence and future success7 • Identify and support a teen’s: • strengths • functional abilities • positive relationships with others • connections to groups, role models, and mentors

20. Middle Adolescence • A key in helping teens avoid violence is to teach them how to: • assess risk and make an immediate decision • think about the long-term consequences of that decision

21. Middle Adolescence Counseling for Parents Help parents with the teen’s dilemma of quick decisions and long-term consequences. If you have guns, how do you store them? How do you stay in touch with your teen? How is your teen getting along with friends? Do you talk about future plans? What non-school activities is your teen involved with?

22. Middle Adolescence Counseling for Youth Teens are living in the moment, but need to think about the future. Do you have somebody to talk to when you feel sad? What do you want to do after high school graduation? Can you get a gun if you want to? What do you like best about yourself? How do you get along with your friends?

23. Middle Adolescence Brochures

24. Teen Suicide and Guns Middle Adolescence • Discusses the risks of guns in the home and the link to completed teen suicides • Objectively discusses guns and gun storage

25. How to Use this Tool • Use on an individual basis to support counseling • Can be distributed to schools and community groups • Parents of teens with mood disorders may benefit from this along with the brochure Help Stop Teenage Suicide Helpful Hints! Did you hear about the teen who killed himself last month? I’m talking about this with all of my teenage patients. Use current events:

26. Connecting With Your Community Middle Adolescence • Teenagers who are involved in their communities are less likely to be involved with: • alcohol • drugs • violence • promiscuous sexual activity

27. How to Use this Tool • As relationships with their parents become more complex, additional adult role models become more important for teens • Support teens in finding adults in the community who believe in and support them Helpful Hints! • Schools and community groups can help find opportunities that meet the interests and talents of young adults • It may be beneficial for clinics to develop a resource guide for teens about local community groups

28. Counseling Schedule: Late Adolescence VISIT INTRODUCE 18 – 21 YEARS • Transition to Independence • Negotiating a New Environment (Post High School)

29. Late Adolescence • Transitioning to independence is a gradual process • Bringing closure to this process is essential • Many older teenagers are likely to be moving out of the home to: • higher education • their own living situation • an entirely new community • This is exciting and stressful for both teen and parent

30. Late AdolescenceCounseling for Youth Support patients with the transition to becoming a young adult. What are your plans down the road? Do you plan to move out of your parents’ home? Whom do you talk to about your future plans? Can I help with getting you where you want to go? How do you feel about moving out?

31. Late Adolescence Brochures

32. Help Stop Teenage Suicide Late Adolescence • Talks about common myths, gives the warning signs, and stresses that many teen suicides occur with little forethought • Designed for teens, parents, and other caregivers

33. How to Use this Tool • Use with patients with mental health issues, especially mood or conduct disorders, that often develop during these years • Stress link between presence of a handgun and increased likelihood of lethal suicide attempts Helpful Hint! • Teens who think they may be gay, lesbian, bisexual, or transgender are at an increased risk for suicide; help them and their families find additional support

34. Next Stop Adulthood: Tips for Parents Late Adolescence • Teens are renegotiating parental relationships as they transition into adult responsibilities • Helps parents let go while encouraging teens to seek guidance from their parents

35. How to Use this Tool • Use as a catalyst to discuss increasing independence • Teens who are already in trouble may need a social worker to help better understand and implement these concepts Helpful Hints! • It is helpful to discuss employment, community service, sports, clubs, and other pursuits • Teenagers need positive engagement with their outside community in order to thrive!

36. References 1. Kingon YS, O'Sullivan AL. The family as a protective asset in adolescent development. J Holist Nurs. 2001;19:102-121 2. Jekielek SM, Moore KA, Hair EC, Scarupa HJ. Mentoring: a promising strategy for youth development. Child Trends Research Brief. Washington, DC: Child Trends; 2002. Available at http://12.109.133.224/Files/MentoringBrief2002.pdf. Accessed June 27, 2005 3. McMahon SD, Singh JA, Garner LS, Benhorin S. Taking advantage of opportunities: community involvement, well-being, and urban youth. J Adolesc Health. 2004;34:262-265 4. Urberg KA, Luo Q, Pilgrim C, Degirmencioglu SM. A two-stage model of peer influence in adolescent substance use: individual and relationship-specific differences in susceptibility to influence. Addict Behav. 2003;28:1243-1256 5. Grunbaum JA, Kann L, Kinchen SA, et al. Youth risk behavior surveillance--United States, 2001. MMWR Surveill Summ. 2002;51:1-62 6. Slaby RG, Guerra NG. Cognitive mediators of aggression in adolescent offenders: I. Assessment. Dev Psychol. 1988;24:580-588 7. Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997;277:918-924

37. Acknowledgments Howard Spivak, MD Robert Sege, MD, PhD Elizabeth Hatmaker-Flanigan, MS Bonnie Kozial Vincent Licenziato Kimberly Bardy, MPH This project was supported by Grant No. 2001-JN-FX-0011 awarded by the Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the U.S. Department of Justice.