Program

Dec 02, 2008

OVERVIEW

This home visiting program seeks to improve outcomes for high-risk families of adolescent mothers. It is intended
for pregnant girls aged 12-18 and consists of curricula that both teach and
model healthy parenting, and encourage education, contraception, and health
care. Evaluations of the Three Generations Project found that mentors
positively impact adolescent mothers, although mixed results were found with
respect to subsequent births, parenting attitudes, and school continuation
rates.

DESCRIPTION OF PROGRAM

Target population: Adolescent mothers

This program stems from research reporting that adolescent
mothers are at high risk for subsequent teen births, depression, school
dropout, and poor parenting. Through the implementation of home visits, this
program provides a parenting curriculum, encourages contraceptive use to delay
future births, promotes school continuation, develops relationship and
negotiation skills, and connects adolescents with primary care.

Home visits begin during the adolescents’ third trimester of
pregnancy or immediately following the birth and continue twice a month during
the child’s first year, and periodically until the child’s second birthday.
During the visits, trained visitors model and teach parenting attitudes, child
development, appropriate health care, safer sexual practices, partner
communication, and goal-setting for school completion.

Home visitors need at least a high school degree and
experience related to the program. They receive two days of concentrated
training in a parenting curriculum specifically designed for urban, African
American adolescent mothers that teaches child development, good parenting
attitudes and skills, and appropriate health care use.

EVALUATION OF PROGRAM

Barnet, B., Liu, J., DeVoe, M., Alperovitz-Bichell, K.,
& Duggan, A.K. (2007). Home Visiting for Adolescent Mothers: Effects on
Parenting, Maternal Life Course, and Primary Care Linkage. Annals of Family
Medicine,
5(3): 224-232.

Evaluated population: A total of 63 pregnant adolescents aged
12-18 who were in their third trimester. Adolescents were recruited from urban
prenatal care sites in a large east coast city and were predominately
African-American and low-income.

Approach: 122 eligible pregnant adolescents were
identified for the study. Adolescents (N=84) were randomly assigned to one of
two conditions. Forty-four pregnant girls were assigned to the home visitation
group and 40 girls were assigned to the control group.

Interviews were conducted of all participants at the
beginning of the program, at the child’s first birthday, and at the child’s
second birthday to measure parenting attitudes and beliefs, depressive
symptoms, school enrollment, subsequent pregnancy and general characteristics.
Beginning in the third trimester, home visitation occurred biweekly during the
child’s first year and then monthly until their second birthday.

Results: Of the 84 participating adolescents, 56
(67%) completed the 2 year program and all assessments. This program positively
impacted adolescent mothers’ parenting attitudes and beliefs as well as school
continuation. Compared with the control group, adolescents who received home
visits had significantly greater improvements regarding appropriate
expectations of and empathy toward their child, with improvement becoming more
dramatic the more they were exposed to the parenting curriculum. Adolescents in
the home visitation group also returned to school and graduated at higher rates
(within 2 years postpartum) than those in the control group (71% vs. 44%).

The home visitation group demonstrated trends toward greater
condom-use consistency, although this trend was nonsignificant. The program
also sought to connect adolescents with primary care, and a nonsignificant, but
positive, trend toward this end was reported.

This program did not have any significant impact on reducing
subsequent pregnancies or increasing hormonal contraceptive use. In addition,
depressive symptoms were not impacted by this program, in spite of providing
therapy and connecting participants to primary care physicians.

Black, M.M., Bentley,
M.E., Papas, M.A., Oberlander,
S., Teti, L.O., McNary, S., Le, K. and O’Connel, M. (2006). Delaying
Second Births Among Adolescent Mothers: A Randomized, Controlled Trial of a
Home-Based Mentoring Program. Pediatrics, 118(4): 1087-1099.

Evaluated population: A total of 149adolescent mothers
aged 14-17 who had very recently given birth and were living with their own
mother. Adolescents were recruited from 3 urban hospitals in a large east coast
city and were African American and low income.

Approach: A total of 181 adolescent mothers were randomly
assigned to the control group (N=94) or the intervention group (N=87). All
participants completed an evaluation at home 3 weeks after the birth of their
child to obtain information on demographic characteristics, relationship
history, health status, access to services and early adjustment to parenting.
Follow-up evaluations were conducted in the home when the child was 6, 13, and
24 months by evaluators who were not informed of the mother’s intervention
status. At each evaluation following the baseline, additional information was
also obtained about subsequent births since the first delivery.

Mothers in the intervention group received home visits every
other week during the first year of the child’s life, with a maximum of 19
visits. Home visitors were women who were also single mothers and presented
themselves as “big sisters” to offer a supportive role rather than an
authoritative one.

Results: This program positively impacted the timing
of subsequent births among recent adolescent mothers. Participants in the
intervention group had significantly reduced odds of having a subsequent birth
during this two year study. Mothers in the control group were 2.5 times more
likely to experience the birth of a second child during this time frame
compared with those in the intervention group.

At the final two year evaluation, there were no additional
significant differences between the intervention and the control groups. Risky
behaviors such as substance use, the mother’s mental health, academic
performance, relationship quality and parental sense of competence were all
unaffected by this program.

SOURCES FOR MORE INFORMATION

References:

Barnet, B., Liu, J., DeVoe, M., Alperovitz-Bichell, K.,
& Duggan, A.K. (2007). Home Visiting for Adolescent Mothers: Effects on
Parenting, Maternal Life Course, and Primary Care Linkage. Annals of Family
Medicine,
5(3): 224-232.

Black, M.M., Bentley, M.E., Papas, M.A., Oberlander, S.,
Teti, L.O., McNary, S., Le, K. and O’Connel, M. (2006). Delaying Second
Births Among Adolescent Mothers: A Randomized, Controlled Trial of a Home-Based
Mentoring Program. Pediatrics, 118(4): 1087-1099.

KEYWORDS: Adolescence (12-17), Young Adulthood (17-24),
Youth (16+), High-Risk, Teen Mothers, High School, Gender-specific (female
only), Black or African American, Home-based, Home Visitation, Life Skills
Training, Mentoring, Tutoring, Urban, Child Care, Early Childhood Education,
Physical Health, Social/Emotional Health, Mental Health, Depression, Education,
School Engagement, Academic Achievement, Reproductive Health, Teen Pregnancies,
Risky Sex

Program information last updated 12/2/08