Et utviklingsperspektiv som ramme for samtaler med ungdom i skolehelsetjenesten : Aktivitet, intensjonalitet og tilpasset utviklingsstøtte

Abstract

Denne avhandlingen omhandler hvordan samtaletilbudet til ungdom i skolehelsetjenesten kan formes på en måte som fremmer de unges aktive deltagelse i sine egne endringsprosesser. Studien er gjennomført innen en aksjonsforskningsstrategi. To team med helsesøstre og kliniske pedagoger ved to videregående skoler i Oslo (2005-2007) deltok. Studiens empiriske grunnlag omfatter fokusgrupper med ungdommer, helsesøstre og skolerådgivere, kvalitative intervjuer med ungdommer ved de to skolene og deltagende observasjon under samtaler mellom ansatte i skolehelsetjenesten og ungdommer. <br> Resultater fra fokusgruppestudien viste at ungdommene og de profesjonelle vektla fire dimensjoner i samhandlingen: omsorg, nøytralitet, konfidensialitet og selvbestemmelse. Disse dimensjonene drøftes i artikkel I.<br> Artikkel II bygger på ungdomsintervjuene. Da ungdommene ble spurt hva som var en hjelp i krevende livssituasjoner, løftet de fram betydningen av at voksne viste at de brydde seg om dem samtidig som de fikk tid og rom til å reflektere og prøve seg fram på egen hånd. På denne bakgrunn ble begrepet omsorgsfull involvering konstruert. Artikkelen drøfter hvordan dette begrepet kan anvendes i samtaler med ungdom i skolehelsetjenesten.<br> Artikkel III bygger på deltagende observasjon under samtaler mellom de ansatte i skolehelsetjenesten og ungdommer. På bakgrunn av denne studien presenteres begrepet intensjonell oppmerksomhet. Begrepet viser til hvordan de profesjonelle på den ene siden hadde bestemte intensjoner med samtalene samtidig som de var lydhøre overfor ungdommenes idéer og meninger.<br> Avhandlingen bygger på en grunnleggende antagelse om at praksis i skolehelsetjenesten kan utvikles ved at praktikerne selv deltar aktivt. Artikkel IV drøfter hvilke betingelser som må være til stede for en praksisbasert kunnskapsutvikling hvor ulike yrkesgrupper deltar.

Much concern has been given to the mental health condition of young people in Western countries. Priority has been given to making professional counselling easily accessible, and in Norway school health services are pointed to as a public field of development.<br> To encounter the mental health needs of young people today, the services need to be improved both in terms of quantity and quality. This thesis addresses the qualitative aspects of counselling. The argument pursued is that school health counselling should be practised within a developmentally-oriented framework that prioritises the active involvement of the young person.<br> This study is conducted within a participative action research (PAR) strategy. Two teams with school nurses and mental health professionals, located at two high schools in Oslo, Norway (2005–2007), participated. The empirical basis of the study comprises focus groups with adolescents and counsellors, qualitative interviews with youth at the two participating high schools, and participant observations during the counselling sessions. The interaction between the counsellors and the adolescents is the focus of the study. The following overall research question is addressed: What are the characteristics of school health counselling when a developmentally oriented perspective that enhances the young person’s active involvement in change processes is taken as a point of departure? This main question is amplified by the three specific research questions: 1) What do youth and counsellors recognize as important dimensions in this kind of counselling? 2) How do young people describe and understand adult support in difficult periods during their lives? 3) How do practitioners transform a developmentally-oriented perspective into practice?<br> Taking the counsellors and adolescents’ views as a point of departure, four recurring dimensions of the counselling emerged as being essential: care, neutrality, confidentiality and autonomy. These dimensions are discussed in Paper I.<br> Theories of youth development employed in the field of youth counselling usually emphasise the autonomy issue. In this study the adolescents’ access to supporting adults who they experienced as caring was highlighted. Based on the narratives of 46 adolescents the concept of caring involvement was constructed. A key dimension of caring involvement was the supporting person’s readiness to be active. At the same time his or her activity should be balanced with promoting and providing space for the young person’s activity. Paper II discusses how this concept can inform school health practice.<br> Paper III introduces the concept of intentional attentiveness. This concept comprises dimensions related to how the practitioners transformed a developmentally-oriented perspective into action. Interaction that claims to enhance the adolescent’s active involvement in change processes was characterized by the practitioner’s intentions of guiding the young person towards a positive direction in life. This approach, however, was carefully balanced with attentiveness to the young person’s own views and ideas. Another argument pursued in this thesis is that school health counselling should be developed ”from within”, that is by active involvement of the practitioners themselves. Paper IV explores the following research question: What kind of challenges might practitioners and researchers encounter when they aim to develop practice together? When using PAR to develop health services, equality among the participants (researchers and co-researchers) is essential. Analysis based on group discussions and experiences gained during the research process demonstrated that equality does not mean ”sameness” or doing the same things. On the contrary, equality implies acknowledging and welcoming diversity among the participants. The development of school health services as multidisciplinary health services is discussed in light of these findings.