Pregnant adolescents and the deficit model.

“This is effin pathetic”. Each week, a teenage girl would slump into the sofa and complain bitterly about having to be at ‘group’.

I was in my early 20s and had been employed to establish a health education program for pregnant or parenting homeless young women aged 18 years or less. They were living in an accommodation service in urban Sydney. Attending these sessions was a requirement. Most were trying to do the best they could, caring for themselves and their babies against sometimes significant obstacles, displaying enormous resilience. Some of them had drug addiction, others had been in juvenile detention, some just needed a place to live and living at home wasn’t an option. Some were under child protection orders to be there or they would lose their children.

Midwifery training did not equip me for this. Nor did nursing. Both were entrenched in the deficit model where if a person is thinking or behaving in the wrong way regarding their health, they lacked knowledge. In nursing it was called a Knowledge Deficit. The Knowledge Deficit needed to be addressed with information. Their wrong knowledge would be righted and they would alter their behaviour or thinking so it aligned with that which was conducive to their health.

My health education program ran on a top-down deficit model. I earnestly but resolutely decided what they needed to know. Sex education, domestic violence,  infection control, cookery.

I also did individual work supporting and advising the girls through their pregnancies, attending antenatal appointments, or the GP clinic when their babies were sick. We put together birth plans. I would hang out with some of them as they smoked on the balcony and lecture them on how bad this was for their babies. I developed posters and pamphlets on how you should not heat bottles in microwaves or how dental caries would come from putting babies to bed with bottles of juice.

None of this made much difference.

After a year I was ready to leave. Before I did, I attended a one day course that changed everything. It was based on William Glasser’s Reality Therapy which asked three simple questions of clients: What do you want? What are you doing? Is it working?

I learnt to work with these young women in a way that honoured their growing need for autonomy but guided them towards better solutions for them and their babies. It revolutionised my work with them.

I held a planning meeting with the girls. I would no longer decide the program, they would. They wrote down what they were good at and what they wanted to learn more about or do more of. Our sessions were now directed by them and peer led by them.

Their approach to group changed completely. The girls were cautiously happy to be there. Health promotion became more than just teaching them how to cook healthy meals. We also painted T-shirts or went to the movies – some badly needed respite and a chance to just be adolescents and have fun. The Christmas before I left, we even performed a puppet play for the children in a nearby child care centre.

Hungry for some theory to inform my practice, I went back to uni and completed a Master of Public Health. Then I did a treatise with Simon Chapman on how the media frames anti-immunisation messages. That publication led to an NHMRC project grant which turned into my PhD that looked at how different parties to debates about the safety of vaccines construct and advance their arguments, what makes vaccine scares ‘tip’ and how to avert this. Margaret Burgess and Penny Hawe were my associate supervisors. I was incredibly fortunate to be guided by these inspiring people.

In the ensuing years I have worked as a social scientist looking at what people think, feel and do about vaccination. In the last few years I have been privileged to be joined by a wonderful team of postgraduates and postdocs. This year, after four years of trying, I got a NHMRC Career Development Fellowship focused on improving communication about vaccination.

The experience with the teenage girls continues to influence me profoundly – in terms of working with communities, public engagement, health communication, the social determinants of health and achieving effective change. It was a lifetime of lessons packed into one very intense 20 months.


1 Comment

  1. Nicely told story Jules, great to hear how your nursing career has twisted and turned and been so interesting. Watch out or you’re goingto end up a full professor 🙂

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