By the end of this unit, participants will be able to:

• Describe situations that can lead to stress.
• Discuss at least three things a person can do to reduce stress.
• Demonstrate ways of helping clients cope with the stress they experience due to the added demands of the birth of a baby.
• Demonstrate ways to get a client to discuss her perception of a problem or need.
• Describe why and how goal-setting and decision-making can empower clients.
• Demonstrate the use of one problem-solving plan, the 4 Step STAR Program. Adapted from Wasik, B. Coping With Parenting Through Effective Problem Solving (Ch. 3, pp. 16-22).
• Explain the physical and emotional responses to stress.
• Recognize appropriate use of supervision.
• Explain the benefits of effective time management through prioritization.
• Guide a relaxation induction exercise or other stress reduction technique.

12 hours

A. Introduction/Definitions
B. Living With Stress
C. Identifying and Solving Problems - STAR 4 Step Problem Solving
D. How Decision-Making Affects Empowerment
E. Problem-Solving Practice Session
F. Practice Time Management Techniques Through a Scheduling Exercise
G. Practice Relaxation Induction Exercises
H. Summary and Review

• Resource Mothers. (1993). Handbook. Sterling, VA: INMED.
• Conceptual Paradigm (Handout #1).
• Identifying Your Stress Signals and Reactions (Handout #2).
• Coping With Stress (Training Aid #1).
• STAR Problem-Solving Process, Training Aid #2/Handout #4.
• Toward a Healthier Lifestyle (Handout #3).
• Practice Role Play Situations (Handout #5).
• Weekly Activities (Handout #6).
• PSS Weekly Schedule (Training Aid #3).
• Role Play Feedback (Overhead #1).
• Post-Unit Evaluation.
• Newsprint, markers, tape, or blackboard and chalk.
• Video Equipment: video camera, tripod, tape, VCR, and television
• Post-Unit Test

• Read the Resource Mothers Handbook, Chapter 3, "A Problem-Solving Approach to Helping Clients Deal With Stress."
• Ask PSS to read Chapter 3 of their Handbook prior to the session.
• Make sufficient copies of any handouts.
• Make any necessary transparencies.
• Try out video equipment. Set up camera to videotape role plays.

1. Discussion. Some of the main points to cover in this introduction follow: Introduction of Pride in Parenting Conceptual Paradigm (Handout #1).

• Explain this conceptual model from the standpoint of daily life and how it is integral to the PIP study.
• Many of the decisions we make are easy, others are more complicated. Ask the group what decisions they have made today. Possible responses might be: what to eat for breakfast, what to wear, whether to read the paper or watch TV, whether to drive or take the bus to this training, etc.
• Problem-solving serves to reduce stress and promote a sense of well-being and personal strength. Solving a problem involves making a decision. We may think about taking some action for a long time or we may just instinctively do it. The key role for the PSS is "to help" her client make her own decisions, as opposed to doing something for her.

2. Present the following - or similar - scenario for discussion: A PSS goes to a client's home. The client, mother of three week old James, immediately tells her she hasn't been able to sleep for the past two nights and she is exhausted. The PSS says to the client, "The same thing happened to me last week. Here's what you do: heat up a glass of milk and add two teaspoons of honey. Come on, I'll make some for you." The client does what the PSS advised and it works. She sleeps soundly and is pleased.

What happened here? Is the problem solved? Discuss. Did the PSS help her client solve a problem? Possible responses might be:

• Clients in our program are expected to be active participants.
• Parenting Support Specialists should promote a more collaborative, partnership-like relationship between themselves and their clients.
• The role of the PSS is to promote self-sufficiency and independence.
• Our program will encourage clients to define their own needs and set preferences for services they wish to receive.
• The PSS's role is not to be the "expert," but rather, the person who helps the client recognize her own strengths in order to solve her own problems and make decisions.

Try to elicit from the trainees that solving a client's problem for her may help alleviate present stress, but it will not give her the tools she needs to be able to deal with future stress. On the other hand, what did happen in the incident described that might be of benefit?

Point out that by using the problem- solving model, Parenting Support Specialists can "model" for the client - and others in their lives - ways to "think through" problems and carry out plans.

1. Distribute Handout #2, Identifying Your Stress Signals and Reactions. Give trainees 5 minutes to fill out this one page summary of reactions to stressful situations and possible ways of coping. Tell them you will discuss their reactions in a few minutes. As an alternative, read each item, one at a time, with trainees and discuss their answers together.

2. Point out that Chapter 3 of the Resource Mothers Handbook contains information about stress, including positive and negative reactions to stress, and ways of coping with stress. You might summarize with some of the following.

• Stress refers to emotional or mental strain or tension. We all experience stress every day, because our lives are stressful. Stress often develops from having: too much responsibility or information; too many emotional concerns; an inability to remedy a bad situation; or, too many changes. Stress is a response to situations that may frighten, excite, worry, confuse, endanger, or irritate. There are different kinds of stress. Three common types are:

• Ordinary: Examples might include: waking up; getting to work on time;

  Developmental: Examples might include: learning a new skill; taking on a new challenge or responsibility.

  Unique: Examples might include: unintended pregnancy; abusive partner; and, dangerous living situations.

  • Ordinary: Examples might include: waking up; getting to work on time;
  • Developmental: Examples might include: learning a new skill; taking on a new challenge or responsibility.
  • Unique: Examples might include: unintended pregnancy; abusive partner; and, dangerous living situations.

Ask trainees for additional examples of each from their own experiences.

3. Ask if stress is good or bad and have trainees give reasons for their opinions. Possible responses might include:

Good:

• Can give a person extra momentum; can actually improve a person's performance at work or home.
• Positive stress can be exciting; help a person gain extra energy to meet challenges.

Bad:

• Can make a person feel irritable, anxious, tired, and depressed. Any of these feelings can cause a drop in a person's energy level, and may cause her to be overly harsh with family, friends, or co-workers.
• Can weaken and disturb the body's defense mechanisms, so a stressed out person is more prone to illness.
• If unrelieved, stress can cause both physical and emotional harm to a person's body.
• May play a role in development of ulcers, heart disease, high blood pressure, and migraine headaches.
• Can affect children or other family members.

4. Discuss the fact that stress is different for different people. What is stressful to you may not be stressful to your neighbor. Life events - such as a marriage, divorce, or a child leaving home - can cause stress and can be either a time of negative or positive change. Positive stress can become negative stress when a challenge becomes long term or when problems persist and are not solved.

5. Suggest that participants discuss some of the "stressors" in their lives. What are some of the stresses of parenting? Of starting a new job? Do they anticipate any stresses when they are out in the community working with clients? (Handout #2)

6. Discuss stress following delivery of a newborn. Point out that even though this can be a very special time for a woman and her family, it can also be a time of added stress. A few points you may want to cover:

• Change is one of the biggest causes of stress, and having a baby is certainly a time of change. There are changes in a woman's body, changes in the way women see themselves and the way others see them, and perhaps changes in their situation at home and/or work. Childbirth adds a whole new set of stress. Many women undergo enormous emotional changes as they worry about the responsibilities of parenthood. This can be particularly true if the woman is very young, unmarried, still a child herself, and/or didn't actually plan to get pregnant and become a mother at this time.
• Shifts in hormone levels following pregnancy may be responsible for mood swings and may make it more difficult for a woman to cope with the daily stresses in her life.
• If the stress is not relieved, and if it is allowed to build up, a woman becomes more susceptible to health problems. Women who react to stress by reaching for a cigarette, a beer, a "joint," or crack cocaine to relieve their tension or anxiety, increase the risk of having a baby being born sickly or with birth defects or may be unable to adequately care for a newborn. Some studies indicate that extreme psychological stress may cause a woman to give birth to a low birthweight baby.
• Let trainees know that if they see (or feel) that any client is overwhelmed by stress at any time, they should make sure she sees her health care provider right away.

7. Share with the group: There are 3 basic ways people generally cope with stress:

• Acting out
• Withdrawal
• Taking charge

Ask for trainees' comments. Ask them for examples of each, from their own experiences, or from what they've observed others do.

8. Activity. Ask trainees to develop a list of "stress relievers" - any activities they have tried that have helped them reduce stress. You can do this as a group or ask individuals to do this alone. Allow them 5-10 minutes to complete the task.

Discuss their stress relieving activities, and why they think these activities worked. Which activities would they be most likely to recommend to new mothers? Why? Ask if anyone else tried some of these activities and found they didn't work. Which ones? Any ideas as to why they weren't helpful in relieving stress? Make a master list on newsprint and develop a list for them to use when making home visits.

Distribute Handout #3, Toward A Healthier Lifestyle. Use this handout to discuss, in some detail, stress relievers such as exercise, relaxation, and the role of diet, hobbies, and recreation in stress reduction. Then review the coping skills outlined in this handout. A discussion of these coping skills can serve as a good lead to the next section on "Identifying and Solving Problems."

9. Activity. Use Training Aid #1 which gives a brief scenario followed by a series of discussion questions. Use these questions as points of discussion. As with any case study scenario, you can process this in any way you choose. Some alternatives: 1) Read the scenario to the group, and then raise the issues found in items A to F and let the group discuss. (If you use this methodology, it sometimes helps to have someone note key ideas on the chalkboard.) 2) Distribute the case study, ask trainees to read the page and then discuss the issues, either as a group, or with a partner. (If you select this approach, the training aid actually becomes a handout, and a copy for each participant will need to be made before the session.)

As facilitator, make sure everyone is heard from, and that all ideas are encouraged.

1. Assure trainees that, before this training ends, they will have the skills necessary to help their clients solve their own problems and make decisions that seem "right" for them. The procedure they will follow is a four-step model designed to help people learn to cope effectively with personal problems in their everyday lives. Each step is an important part of the total problem-solving process.

2. Tell trainees they first will practice using this model to solve some of their own problems. Once they are comfortable using the model, they will be able to explain the process to their clients and "walk" them through it, step-by-step. As Parenting Support Specialists use this model with clients, they will be transferring problem-solving skills that will help their clients reduce stress in their lives.

This problem-solving model has been used successfully with diverse populations, both with "everyday" problems as well as "special needs" problems such as families affected by drug and alcohol, single parents, teen parents, depressed pregnant and parenting women, and parents of handicapped children.

3. Teaching Parenting Support Specialists to use the 4-step Problem-Solving for Parents Model will help them with their own problems and help them to help their clients. Discuss the following points as background information. It will set the stage for working to solve problems and make decisions.

• PSS' have to make decisions and deal with problems every day.
• For most problems, PSS' can learn to do something to make the problem situation better.
• A few problems may be ones PSS' cannot change, but have to learn to live with.
• Confronting and dealing with problems usually ends up making their lives more pleasant. PSS' will also feel more confident of their abilities to solve problems in the future.
• PSS' will usually solve problems better if they think about them first before doing something about them.

4. Ask someone to volunteer one problem she had to deal with this week or that she tried to help someone else deal with this week. Teaching PSS' to use the 4-step problem-solving model will help them with their own problems (Training Aid #2/Handout #4). Point out that although these steps are numbered consecutively, 1 through 4, actual problems are not always solved in this linear progression. With certain problems, the "problem-solver" may move back and forth among some of the steps. This is because problems and circumstances in their lives may change from day to day.

5. In solving a problem, a person has to answer questions and think through what she will do. Oftentimes there will be more than one option, and the option that first comes to one's mind may not be the best one. Go through each of the first 3 steps and make sure the steps and tasks are clear.

For example, if the problem posed by the participant who volunteered (see #5 of Trainer's Notes above) was "My clothes are all too tight and I have almost nothing to wear." As a group, look at the steps, talk about what to consider, and then have the group discuss possible answers. In this case the problem could be "I'm gaining too much weight," but it could be that the person is putting all her clothes in the laundromat dryer and they are shrinking. So first you must agree on precisely what is the problem or concern.

Then move on to the next step and again, as a group activity, discuss what the woman wants to have happen. They will probably agree to a goal such as "I want all my clothes to fit well so I feel comfortable." Continue in this fashion through the first 3 steps.

By the time the group has finished discussing step 3, they will probably have come to a decision. What has to happen now? Answer: Some action must be taken. And if no action is taken, what happens? Will the problem get solved? Probably not. The 4th step in the process is responding or taking action. This step requires that a person do something. Thus, to properly solve a problem, a person has to do two things. What are they? Expected response:

Think about the problem and then act.

What happens after the person acts? She must ask herself if she solved the problem. Did her action work? If not, she again needs to think about why not, and what else she needs to do.

6. Review key points.

• Stop, Think, Ask, Respond, and Check-STAR

Discuss: Why is it important to stop? Where is a good place to think? Sitting quietly? Walking to work? Any place? Why? Why is it important to ask ourselves what might happen with each choice? Why is it necessary to respond or act? And finally, what do we do to see how our plan worked?

7. Team activity. Begin this activity by sharing a problem and walk trainees through the process, as you would go about solving it. Example of possible problem:

"The day care provider called to say my baby Andy is sick and I should come get him. But our training session won't end for several hours and I know the Program Director is counting on me to stick to the schedule."

Then ask each trainee to write down three problems that she encountered within the last week or two. Next, have everyone pick a partner. Together, they should select one of the problems one of them jotted down, and discuss how they should go about solving it. They should be sure to cover all four steps, including what action is going to be taken. Ask the person who presented the problem if this is the same decision that was reached when the problem actually arose. If not, why might this decision be different? Was it because they took time to consider different alternatives before rushing into a decision?

When the teams finish, they should pick one of the "real life" problems encountered by the other team member. Repeat the same procedure.

8. Bring the group back together and process what went on. Ask someone to describe how it felt to use this problem-solving process. Do they think it is possible to use this process and still not solve their problem? Discuss reasons why or why not. Point out that many people don't like to make decisions.

Sometimes people think that if they just ignore a problem, or pretend it doesn't exist, it will just go away. Is this realistic? Why or why not? Making a decision lets you decide about your life. Thinking about the decision helps you focus on what is important to you. And any decision you make should be yours, and not something that someone else decided for you. Everyone is unique (as discussed in Unit 2), and each must consider the consequences of decisions and actions in terms of individual values and priorities, and what is believed to be best in any given situation.

9. Explain that as soon as trainees feel comfortable using this problem-solving model to solve their own problems, they will be ready to transfer this process to their clients. (Tell them it also works with relatives and friends.) As PSS' help their clients use this approach for problem-solving and decision-making, they will notice that it helps clients gain power and control over their lives.

10. Make sure everyone's questions are answered and comments heard before moving on.

1. Ask trainees to take out a piece of paper. Ask them to jot down whatever comes into their mind when they hear the word "empowerment" or the action form of this word, "empowering." They should try to define what these words mean to them, and also give examples - from their own lives or from the experience of someone they know - of things they have done that have given them a sense of empowerment. They may want to reflect back to their River of Life (Unit 1). This is not a test and you won't collect their papers. Allow about 10 minutes.

2. Ask for a volunteer to share her definition of empowerment. Write key points on newsprint or the chalkboard. Ask others to add to this definition. After each person has contributed, work as a group to compose a workable definition of empowerment. It might look something like this:

A feeling of self-worth and self-confidence that allows people to define their own goals and make good decisions and choices for themselves.

3. Next ask the trainees to share the experiences they noted on their papers that led to a feeling of empowerment. Encourage everyone to contribute. Base your "processing" of their comments on what trainees had to say. For example, did more than one participant have a similar example? If so, was this strictly coincidental? Or might there be other reasons? Discuss these reasons. If not exactly alike, do the examples have a common thread? (The group will probably find that many examples have to do with asserting themselves, making a decision and then following through with an action, and then feeling good about themselves when they achieved the result they wanted.)

4. Discuss with trainees why being a "helper" is a challenge, but also a real opportunity: to help clients take control of their own lives. As PSS' help clients confront and then work to solve their problems, they will help women feel better about themselves. This will happen -- gradually, to be sure -- as clients gain confidence in their ability to make choices that are right for them.

5. Before moving on, make sure everyone understands this close relationship between decision-making (and problem- solving; the two terms are so closely related) and empowerment. In the next unit, "Helping Clients Build Self-Esteem and Deal With Feelings," the idea of empowerment is further explored.

1. Activity. Consult Handout #5 which contains some practice role play situations. Ask each trainee to select a partner with whom to work. Assign each one a role play scenario. Although eventually the teams will act out their scenarios, tell participants that they should first discuss the problem situation with their teammate and outline how they will go about working through the problem-solving process. Suggest they may even want to jot down some notes to better remember their game plan. Then they are ready to role play a home visit.
2. Depending on the size of your training program and the number of new scenarios created for the program, you may want to distribute the same role play scenario to each team, or assign different ones simultaneously. Allow enough time so that each trainee gets to "play" her own role in 2 to 3 different scenarios, and more if your observations indicate participants need more practice.
3. As the teams are working, move among the groups so you can observe/hear what's going on. It's okay to offer advice, but be sure to explain the reason for any suggestions given.

1. Have members of the group offer examples of ways in which they have organized their schedule to be most efficient.

2. Have group participants talk about their own strategies for reminding themselves about what needs to be done.

3. Discuss some of the scheduling needs participants will need to consider in fulfilling their role as a PSS.

Activity. Have participants look over the list of activities described in Handout #6. Review the different approaches and perhaps decide on what would be effective for the team as a whole. Develop a tentative weekly schedule that could be used at each site. (Training Aid #3).

1. Explain that a person can train herself to move into a relaxed physical state. Once a person has learned to do this, it can counteract states of stress and tension.
2. PSS's may themselves experience a great deal of stress in assisting the families in the project with their complex problems. Learning a relaxation exercise may help them deal with these reactions. They will also be able to pass on this technique to the mothers so that they too can reduce their stress by practicing a relaxation technique.
3. Teach the PSS's the relaxation procedure and allow practice time.
4. Some people find that meditation works for them in a similar way. Have PSS's describe any methods they have learned for producing a relaxed state.

1. Follow one of the procedures outlined in Units 1 or 2. Be sure to rotate, so it's not always the same participant who's summarizing the session. If you refer back to the objectives and re-word them as questions, then trainees can take turns responding.
2. Distribute and ask participants to complete a post-unit evaluation form. Remember that, if you later learn when reading these forms that certain topics were not well understood, you will want to modify your training program so as to re-emphasize any important material that remains unclear. This is one of the strengths of doing some kind of brief evaluation at the end of each unit: you still have the ability - and time - to alter your schedule. If you wait until the end of the entire training course to find out its weaknesses, it's usually too late to take any sort of compensatory action.
3. Distribute Post-Unit Test.