Enhancing Adolescent Brain Development through Goal-Setting Activities

PRACTICE UPDATE

Enhancing Adolescent Brain Development through Goal-Setting Activities

Megan K. Scarborough, Carol M. Lewis, and Shanti Kulkarni

E ffective goal setting is a critical sociocognitivedevelopmental exercise that enhances humanfunctioning across the life span (Bandura, 1997; Schunk, 2001 ; Schunk & Zimmerman, 1997). Social learning, social exchange, and self-regulation theories all shed light on how the goal-setting pro- cess can build self-efficacy, social networks, and even brain development itself Emerging evidence from neuroscientific studies on human brain develop- ment supports speculation that exercising executive functions and social cognitive skills (such as setting and working toward goals) during adolescence may shape brain function across the life span (Blakemore & Choudhury 2006; Giedd, 2004). Client-driven goal setting has long been a basic tenet of social work, but practitioners should think beyond the concrete aspects of goal achievement and view the goal-setting proce55 itself as a means to enhance cognitive and social development.

This Practice Update examines a simple, low-cost tool for facihtating client-driven goal setting that was developed by Life Works Teen Parent Services (TPS), an intensive case management intervention for pregnant and parenting adolescents. A thor- ough examination of the hterature reveals that, on some level, goal setting is included in a number of adolescent pregnancy programs with proven track records for effectiveness. Demonstrating the utility of goal setting in diverse settings, these programs’ formats vary widely to include nurse and mentor home visitation models, school-based group brief therapy models, and community-based models, to name a few (Black et al,2006;Brown, 1999; Harris & Franklin, 2007; Isaacs, 2007; Tabi, 2002). Yet in the literature, details remain vague about how and why goal-setting exercises should be incorporated to ensure consistency in service programs intended to promote decision making, social problem solving, interpersonal relationship skills, and self-efficacy. The centerpiece of the Life Works TPS goal-setting

approach is a simple, fiU-in-the-blank worksheet. Its open design and individual client focus give it a universal quality and make it relevant for various populations and diverse social service settings. It is particularly useful for interventions that serve preg- nant and parenting teenagers, in which the arrival of a new baby sparks a crucial need to accelerate the development of parenting skills, social support networks, and self-sufficiency.

THEORETICAL SUPPORT Social learning, social exchange, and self-regulation theories all shed light on how the goal-setting pro- cess can build self-efficacy, social networks, and even brain development itself Cognitive self-regulation is a critical function that organizes thoughts, feelings, and actions toward goal attainment. Self-regulation is conceptualized as having multiple sequential phases related to goal attainment—forethought (identifying the goal and the necessary action steps),performance control (carrying out the steps and monitoring performance), and self-reflection (evaluating one’s goal progress and adjusting strategies as needed to ensure success) (Schunk, 2001; Zimmerman, 1998). Short-term, task-oriented goals are preferable to distal, long-term ones because they deepen the cognitive experience by providing individuals clear markers of progress and allowing them to judge their performance (Bandura, 1982).Whereas distal goals can be vague and elusive (for example, I want to be financially stable),proximal subgoals provide imme- diate incentives and guides for action (for example, I will submit five job applications by Sunday).The achievement of short-term goals serves as a vehicle in the development of learning, mastery, coping skills, self-motivation, and self-direction. Tangible goal achievement can also serve to ameliorate feel- ings of anxiety, despondency, and futility associated with an inability to influence one’s environment (Bandura, 1982).

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Social exchange theory sheds light how and why the client—case manager team approach to goal set- ting helps chents expand social support networks and resource connections (Cook & Rice, 2003). Social exchange theory also posits that human be- havior and networking are propelled by incentives and rewards, such as positive reinforcement, mutual satisfaction, moral support, and control. Empowering the client to identify personal goals puts the chent in the driver’s seat, creating balance and motiva- tion in the client-case manager relationship. The process of collaboration with case managers also builds interpersonal skills, laying the groundwork for clients to pursue other, similar relationships and the resources they afford.

EVIDENCE FROM THE FIELD OF NEUROSCIENCE Emerging evidence on adolescent brain develop- ment supports the social science theories that effective goal setting is a critical sociocognitive developmental exercise that enhances human func- tioning across the hfe span (Blakemore & Choud- hury, 2006; Giedd, 2004). During adolescence, the brain undergoes a number of important changes. Predominant among these is the increase in func- tional specificity—the relationship between brain anatomy and its function (Toga,Thompson, & Sow- ell, 2006) .When young children perform cognitive tasks, like remembering telephone numbers, they engage relatively large brain regions. As children develop, the amount of brain needed to perform these same tasks decreases, suggesting an increase in efficiency (Casey, Giedd, &Thomas,2000).This increased efficiency appears to be related to synaptic elimination, or pruning (Blakemore & Choudhury, 2006; Giedd, 2004). During adolescence, synaptic pruning is most pronounced in the prefrontal cortex, which is responsible for executive func- tion (D’Esposito, Posde, & Rypma, 2000). Thus, adolescence is associated with increased brain efficiency when performing executive functions. The emergent hypothesis is commonly associated with the “use it or lose it” adage, suggesting that if an individual exercises executive function and social cognitive skills during peak periods of ado- lescent brain development, his or her brain may become hardwired for such thought processes for a lifetime. Not exercising executive function and social cognitive skills during this time may represent a lost opportunity.

LIFEWORKS TPS GOAL-SETTING TOOL Life Works TPS, a community-based program in central Texas, provides a range of services for preg- nant and parenting adolescents within a strengths- based, youth development framework. Intensive case management links clients to an array of educational, parenting, job training, medical, and mental health support services offered through its parent agency. Life Works, Inc. Chents range between 11 and 19 years, approximately half are pregnant, and half are parenting at intake. Case managers carry a caseload of 20 clients, often for a period of two to three years. Life Works TPS and the Tandem Collabora- tion, another intensive case management program, are partners in a five-year evaluation of a feder- ally funded Adolescent Family Life Demonstration Project grant.The project is investigating the effect of these intensive case management services on chent outcomes. Early on. Life Works’s goal-setting approach caught the attention of evaluators because of its aim to help clients find direction in their Hves by clarifying complex goals into simple steps.

Life Works case managers guide clients in setting individualized goals and engage them in a collab- orative process of goal attainment and monitoring. Goal setting begins during intake, and case managers focus on goals with clients at each contact. New goals are set every three months. Pregnant and par- enting adolescents thus become more focused and deliberate in addressing challenges and identifying needs and aspirations one step at a time.

A single-page instrument was developed to en- courage consistency across chents and case managers in the goal-setting process. All case managers and clients complete a one-page, fiU-in-the-blank “ser- vice plan” worksheet, which also serves as a contract. Using the service plan as a guide, the case manager asks the client to identify a goal or a challenge. Next, one to four “action steps” are identified and assigned a person who will be responsible for carrying out each step (typically the client, the case manager, or both). Education, parenting, health, housing, and basic modern-day life skills required to “navigate the system” are the areas most often covered in these service plans, although they may also include goals related to interpersonal relationships and emotional well-being. For example, a chent identifies the goal to “get back in school.” Two action steps—filling out the paperwork and turning it in by the deadline—are assigned to the client. The case manager is assigned the task of giving the student a ride to the school to

SCARBOROUGH, LEWIS, AND KULKARNI / Enhancing Adolescent Brain Development through Goal-Setting Activities 277

turn it in. Once goals are set, case manager and client agree on a due date for each task. A list of strengths/ assets and barriers/obstacles to achieving the goal are noted. The case manager follows up in person or by phone to monitor the status of the tasks on or near the assigned due dates.The case manager notes the type of follow-up in addition to the progress or lack of progress made in completing the tasks. If steps are not completed, the case manager works with the client to recognize the barriers, revise the strategy, or establish a new goal.

IMPLICATIONS Social science theories and emerging evidence from the field of neuroscience support the asser- tion that the process of client-driven goal setting promotes sociocognitive development, interpersonal relationship skills, and self-efficacy. The Life Works TPS goal-setting approach leads the case manager- client relationship in a direction that is meaningful, tangible, and empowering for the client, while allowing the case manager to guide and support in a modeling role. Helping to ensure consistency in the goal-setting process across case managers, the instrument used also holds vast potential for evaluation and planning. In addition to revealing the most prominent perceived needs of the client population, an analysis of service plans could show differences in perceived needs between subgroups (for example sex, race, ethnicity, age, and so forth). For process evaluation, an analysis of these data could show differences between case managers and the division of labor between client, case manager, and others in the goal-setting process. For outcome evaluation, client outcomes could be linked to service plan content to recognize characteristics, identify patterns, and deepen understanding about how best to allocate resources and address gaps in service to chents. H5D

REFERENCES Bandura, A. (1982). Self-efFicacy mechanism in human

agency. American Psychologist, 37, 122-147. Bandura,A. (1997). Setf-efficacy:The exercise of control. N e w

York: Freeman. Black, M. M., Bentley, M. E., Papas, M. A., Oberlander, S.,

Teti, L. Q , McNary S., et al. (2006). Delaying second births among adolescent mothers: A randomized, controlled trial of a home-based mentoring program. Pediatrics, 118, elO87-elO99.

Blakemore, S. J., & Choudhury, S. (2006). Development of the adolescent brain: Implications for executive func- tion and social cognition. Jonraa/ of Child Psychology and Psychiatry, 47(3-4), 296-312.

Brown, H. N. (1999). Preventing secondary pregnancy in adolescents: A model program. Health Care for Women International, 20(1), 5 -15 .

Casey, B. J., Giedd,J. N., &Thomas, K. M. (2000). Struc- tural and functional brain development and its rela- tion to cognitive development. Biological Psychology, 54(1-3), 241-257.

Cook, K. S., & Rice, E.W. (2003). Social exchange theory. In J. DeLamater (Ed.), The handbook of social psychology (pp. 53-76). New York: Kluwer Academic/Plenum Publishers.

D’Esposito, M., Postle, B. R., & Rypma, B. (2000). Pre- frontal cortical contributions to working memory: Evidence from event-related fMRI studies. Experi- mental Brain Research, 133{\), 3 – 1 1 .

Giedd, J. N. (2004). Structural magnetic resonance imag- ing of the adolescent brain. In R. E. Dahl & L. P. Spear {Bds.), Adolescent brain development: Vulnerabilities and opportunities (pp. 77-85). New York: New York Academy of Sciences.

Harris, M. B., & Franklin, C. (2007). Taking charge:A school- based life skills program for adolescent mothers. N e w York: Oxford University Press.

Issacs,J. B. (2007). Cost-effective investments in children. Budgetingfor National Priorities. Retrieved from http:// www.brookings.edu/papers/2007/01childrenfamilies_ isaacs.aspx

Schunk, D. H . (2001). Self-regulation through goal setting (Report No. ED-99-CO-0014).Washington, DC: U.S. Department of Education, Office of Educational Research and Improvement. (ERIC Document Restoration Services No.ED462671)

Schunk, D. H., & Zimmerman, B. J. (1997). Social origins of self-regulatory competence. Educational Psychologist, 52(4), 195-208.

Tabi, M. M. (2002). Community perspective on a model to reduce teenage pregnancy. Journa/ of Advanced Nursing, 40(3), 275-284.

Toga, A.W.,Thompson, P. M., & Sowell, E. R. (2006). Mapping brain maturation. Trends in Neurosciences, 29{3), 148-159.

Zimmerman, B. J. (1998). Developing self-fulfilling cycles of academic regulation: An analysis of ex- emplary instructional models. In D. H. Schunk & B. J. Z i m m e r m a n (Eds.), Self-regulated learning: From teaching to self-reflective practice (pp. 1—1,9). N e w York: Guilford Press.

Megan K. Scarborough, BA, is project manager. Life Works Care Grant Evaluation, and Carol M. Lewis, PhD, is associate director, Center for Social Work Research, School of Social Work, University of Texas of Austin. Shanti Kulkarni, PhD, is as- sistant professor. Department of Social Work, University of North Carolina at Charlotte. This project was supported through the Office of Adolescent Pregnancy Programs, Office of Population Affairs, and the Department of Health and Human Services; its contents are the responsibility of the authors and do not necessarily reflect the official views of these agencies. Address correspondence to Megan K. Scarborough, Center for Social Work Research, University ofTexas at Austin, 1925 San Jacinto, Suite 3.208, Austin, TX 78712; e-mail: megan@mail.utexas.edu.

Original manuscript received September 10, 2008 Accepted January 23, 2009

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