Program

Sep 24, 2010

OVERVIEW

The
Computer-Assisted Motivational Intervention-Plus (CAMI-Plus) seeks to prevent
rapid subsequent births among adolescent mothers. The program begins
approximately six weeks after birth and continues quarterly for two year.
Participants receive motivational interviewing with a counselor to help increase
motivations to use contraception and not become pregnant. Participants also
receive home visitations. An evaluation performed two years after the birth of
the first child found a reduction in repeat births among adolescents in the
CAMI-Plus intervention group compared with the usual care control.

DESCRIPTION
OF PROGRAM

Target
population:
Pregnant adolescents, aged 12 to 18.

The
Computer-Assisted Motivational Intervention-Plus (CAMI-Plus) seeks to prevent
rapid repeat births (subsequent births less than two years after the first
birth) among pregnant adolescents. The program begins approximately six weeks
after birth and continues quarterly for two years to prevent a subsequent birth
during this time frame (approximately nine sessions). This program is based on
the transtheoretical stages of chance model. Using a laptop computer,
participants answer a series of questions about their current sexual
relationships along with their intentions and behaviors towards contraceptive
use and condom use. A computer algorithm produces each participant’s stage of
change (transtheoretical model) for contraceptive use and condom use, which then
ranks their risk for pregnancy and sexually transmitted infections. Based on
these findings, a 20-minute individualized motivational interviewing session
then takes place with a counselor. These sessions allow the counselor to help
increase participant’s motivation to use contraception and not become pregnant
two years after giving birth. Counselors are African-American paraprofessional
women residing in the same communities as participants. Counselors receive up to
two-and-a-half days of training on the transtheoretical stages of change model,
motivational interviewing, and the protocols.

Additionally,
participants receive bi-weekly or monthly home visitation sessions, which
include parent training and case management. Home visitation sessions are
delivered through use of a curriculum, which is based on social cognitive theory
and developed specifically for African-American adolescent mothers.

Another arm of
this intervention was developed, CAMI, which did not include home visitations.
The CAMI program, along with the evaluation findings, is reviewed in a separate
LINKS write-up.

EVALUATION(S)
OF PROGRAM

Barnet B, Liu
J, DeVoe M, Duggan AK, Gold MA, Pecukonis E. (2009). Motivational Intervention
to Reduce Rapid Subsequent Births to Adolescent Mothers: A Community-based
Randomized Trial. Annals of Family Medicine, 7(5): 436-445.

Evaluated
population:
A total of 150 adolescent females between 12 and 18 years of age
who were more than 23 weeks pregnant were recruited for the study. Participants
were recruited from five prenatal care clinics serving low-income, predominately
African-American communities located in Baltimore, MD. Approximately 42 per
cent of the study sample had dropped out of school and 61 per cent live with
their mothers. About 74 per cent were still with their baby’s fathers. Eleven
per cent had had a prior birth and 31 per cent had had a prior pregnancy.

Approach:
After completing the baseline interview, participants were randomly assigned to
the CAMI-Plus intervention group (n=82), the CAMI-only group (n=87), or the
usual care control group (n=68). The primary outcome assessed was repeat birth
occurring two years after the birth of the first child or earlier. Repeat births
were measured through collecting birth certificate records. Participants were
also assessed on demographic characteristics, living arrangements, relationship
with baby’s father, future intentions towards contraception use and pregnancy,
sexual decision-making competence, depressive symptoms, substance use, and
social support. Interviews were conducted at baseline as well as 24 months
postpartum.

Results:
Adolescents who participated in the CAMI-Plus intervention group were less
likely to have a rapid repeat birth than Adolescents in the usual care control
group (ES=.29).

SOURCES FOR
MORE INFORMATION

References

Barnet B, Liu J,
DeVoe M, Duggan AK, Gold MA, Pecukonis E. (2009). Motivational Intervention to
Reduce Rapid Subsequent Births to Adolescent Mothers: A Community-based
Randomized Trial. Annals of Family Medicine, 7(5): 436-445.

KEYWORDS:
Adolescents (12-17), Youth (16+), Female Only, Black/African American,
Adolescent Mothers, Reproductive Health, Teen Pregnancy, Sexual Activity, Condom
Use and Contraception, Home-based, Community-based, Computer-based, Home
Visitation, Depression/Mood Disorders

Program
information last updated 9/24/10.