Teaching Kids to Raise Their Kids

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For years, the good news about teen pregnancy has been that it’s going down. The national teen birth rate fell from 61.8 per 1,000 females ages 15 to 19 in 1991 to 41.6 per 1,000 in 2003, according to the U.S. Department of Health and Human Services (HHS).

The bad news: That still means 500,000 babies are born to teen mothers each year, HHS says. Most of those births pose risks for both the mothers and the children.

Studies show that teen mothers are less likely than other girls to finish high school and more likely to depend on public assistance. The National Campaign to Prevent Teen Pregnancy says children of teen parents are more likely to be abused, enter the juvenile justice system, become sexually active at a young age, and use drugs and alcohol.

Despite the large need for services, however, “there is not a good body of research indicating what really helps teen parents,” says Pat Paluzzi, CEO of the Healthy Teen Network (HTN), a Washington-based membership organization that serves as a resource on policies and practices.

Researchers do know that the key components of efforts to help pregnant and parenting teens are home visits and case management, Paluzzi says. Within that framework, youth workers can address such issues as parenting skills, pregnancy prevention, job training and continuing education. As with many youth development programs, another key is giving teens stable relationships with trusted adults.

Sometimes those are relatively short-term relationships, such as a doula guiding a teen through pregnancy, birth and her initial months with her baby. The Denver-based National Nurse-Family Partnership, on the other hand, strives to create relationships that start early in the pregnancies and last for two years after the birth. Other programs focus almost completely on medical care and knowledge, but stick with the mothers and babies for up to five years after the birth.

Most ambitious of all are residential programs, often known as second-chance homes. Churches and other nonprofits have been operating group and maternity homes for teen mothers for decades. Catholic Charities agencies, for example, have provided live-in care for pregnant women and their children since 1910.

In recent years, organizations such as the Child Welfare League of America and the Social Policy Action Network have pressed for the creation of more second-chance homes, and some state governments have boosted their support. Massachusetts, New Mexico and Georgia have built second-chance home networks in partnership with community-based organizations.

Getting federal funds for teen parenting programs, on the other hand, has been tricky. Ever since his 2002 budget proposal, President Bush has proposed from $10 million to $33 million a year for “maternity group homes,” but Congress has never funded the proposal.

Such programs can still tap into some federal money. The U.S. Family and Youth Services Bureau (FYSB) offers assistance to pregnant and parenting teens through the Transitional Living Program (TLP) for homeless and runaway youth. Funds are also available to serve teen parents under Temporary Assistance to Needy Families (TANF). But the teen must live with an adult or in a second-chance home and must be enrolled in an education program. She can receive the assistance for up to five years.

Considering that the average age of self-sufficient independence in the United States is about 24, says Paluzzi, “to do all that with a child is going to be difficult. If you have a child at 16, by 21 you are expected to have completed college and be raising the child. Those are pretty impossible odds.”

Following are profiles of four programs that have tried different approaches to helping pregnant and parenting teens:

Nurse-Family Partnership (NFP)
Erie County Department of Health
Erie, Pa.
(814) 451-6733

The Approach: NFP is a comprehensive home visitation program that aims to help low-income, first-time mothers throughout their pregnancies and the first two years of their children’s lives. NFP has been replicated in 23 states, with some 13,000 families served nationwide. The project in Erie is one of the replications.

“It’s really an asset-based program,” says Charlotte Berringer, director of the NFP project in the Erie County Department of Health. “The nurse helps the mother identify support she has in the community,” looking for such resources as education and job training.

Women get into the program through recruitment by NFP and referrals from social welfare agencies and schools.

A specially trained nurse is assigned to the mother in the early stages of pregnancy, ideally within the first 28 weeks. “It is really important to establish rapport with the parent very early on,” Berringer says.

The nurse visits the mother’s home weekly for the first month after enrollment in the program, then twice a month for the rest of the pregnancy. After the birth, the nurse visits once a week for six weeks, then twice a month until the child is 21 months old, and once a month until the child reaches 2 years old.

History and Organization: Dr. David Olds and several colleagues started NFP in 1977 as a clinical pilot study in Elmira, N.Y., sending registered nurses to visit first-time, low-income mothers. Olds conducted more clinical studies in Tennessee and Colorado, then launched more NFP sites in 1997.

The Erie NFP received its initial funding in late 1999 as part of a juvenile delinquency reduction plan produced by a community collaboration called the Policy and Planning Council for Children and Families. It began seeing clients in the fall of 2000.

The National Nurse-Family Partnership, based in Denver, helps communities set up local NFP sites. A site is required to have a minimum of four full-time nurses and a half-time nurse supervisor. Nurses are sent to Denver for training.

Youth Served: NFP accepts mothers of all ages, but about 60 percent of those in Erie are under 18. “We have about 90 to 100 families at any given time,” Berringer says. “Sometimes we have a waiting list, and other times we are recruiting.”

Staff: The Erie NFP has four nurses, each serving a maximum of 25 families, along with a staff supervisor and a project director.

Funding: The Erie NFP’s cost is estimated at $375,500 for 2006. The program is funded by the Erie County Office of Children and Youth and the Pennsylvania Department of Public Welfare. In the past two years, the Erie County NFP has received $50,000 annually from the U.S. Health Resources and Services Administration.

Indicators of Success: NFP says its clinical trials showed that during the first four years of a child’s life, the children of mothers in the program experienced fewer hospital visits for injuries, while the mothers had fewer unintended subsequent births, higher rates of marriage and employment, and less use of welfare and food stamps.

A 15-year follow-up of the original program in Elmira showed that when compared with nonparticipants, the children of mothers in the program had experienced significantly less abuse and arrests, while the mothers had significantly fewer convictions and sexual partners, and they smoked cigarettes and drank alcohol less often.

No outcome evaluation has been completed of Erie’s NFP program. A quality assurance follow-up by the University of Colorado declared that the program is “implementing with fidelity.”

Doula Project
Chicago Health Connection
Chicago, Ill.
(312) 243-4772

The Approach: Named after the Greek term for a woman who helps a new mother through childbirth, this program trains women in the community to do exactly that.

“We show them how to advocate for themselves and their babies,” says Aparanji Mirtipati, associate director of the Chicago Health Connection (CHC), the nonprofit that runs the Doula Project. “The mothers we train learn much more about being a mother and how to have a healthy baby. We show them how to bond.”

The doulas help teen mothers through pregnancy and birth, offer lessons on parenting skills, and help connect them to health care.

The aim is to have the doula become involved with the teen mother no later than the eighth month of pregnancy. The doula visits the young mother’s home each week to discuss the pregnancy, offer advice and answer questions. She accompanies the mother on at least two prenatal doctor’s visits. The doula is present for the birth, the first breast feedings and the initial times the mother and baby spend together.

The doula visits the mother’s home three times within the first week after the birth, then makes weekly visits for at least 12 weeks. The doula helps the mother understand her baby’s capabilities and needs, checks for possible problems, offers support and advice, and helps the mother form short-term goals, such as preparing to return to school and finding a job.

History and Organization: The project was initiated in 1995 by CHC, the Irving Harris Foundation and the Ounce of Prevention Fund. The Irving Harris and the Robert Wood Johnson foundations provided initial funding of $700,000.

CHC does not provide the doulas itself. Three community-based agencies served as pilot sites by implementing doula services in their teen-pregnancy programs with CHC’s help. Planning, along with doula recruitment and training, began in July 1996, and the first births under the program occurred in early 1997.

CHC has helped to create doula projects in six other states and at 18 sites in Illinois. Programs can be tailored to the communities. A doula project in Paterson, N.J., for instance, focuses on drug-addicted pregnant women.

Youth Served: About 750 pregnant and parenting teens, ages 13 to 19, in the Chicago area each year.

Staff: Community women who are trained by the CHC to be doulas. Approximately 50 doulas have been trained since 1996, and there are 14 active doulas in Chicago.

Funding: CHC spends about $360,000 a year to provide training and other help to the provider agencies. CHC’s funders include the Girl’s Best Friend and Robert Wood Johnson foundations.

Indicators of Success: A study conducted by the Ounce of Prevention Fund and released in 2003 reported that mothers who had received the doula services: had significantly lower rates of caesarean sections and forceps/vacuum-assisted births than did teen mothers in Chicago overall; had significantly higher rates of breast feeding than the national average among teen mothers; and were less likely to have premature or low-birthweight babies or poor prenatal care, than teen mothers in Chicago overall. It also found that, for a variety of reasons, almost one-fifth of the mothers did not have a doula present at the birth.

St. Andre Home
Biddeford, Maine
(207) 282-3351

The Approach: Four facilities in three towns house and assist pregnant and parenting young women, referred mainly by Maine’s Department of Health and Human Services. Services include medical care planning and prenatal care, counseling, and comprehensive parent training.

“What we want to do is teach these teenagers how to be parents, which is very challenging,” says St. Andre Director Peter Fitzpatrick. “Especially because we’re dealing with a population of young mothers and children who have, for the most part, been neglected.”

The four houses serve a total of 34 pregnant and parenting women. The residents must be eligible for Medicaid and be pregnant or parenting a child younger than 3.

Each home is in a residential neighborhood and is staffed around the clock. Residents share a living and dining room, kitchen, playroom and other common areas, and they share a bedroom with their children.

During the day, the women attend individual and group activities built around parenting and life skills. St. Andre’s style of teaching is “informal,” Fitzpatrick says; the women learn how to care for children through behavior training and observing others.

The sessions are conducted by both group home staff and outside consultants.

Residents also carry out responsibilities such as cooking evening meals, and they learn budgeting skills.

They meet at least once a week with the home social workers, and some also meet regularly with a psychiatrist who comes to the homes.

The women can attend a local high school, participate in a GED program or get help from St. Andre’s in finding jobs.

Women can live at St. Andre’s for up to two years.

History and Organization: The Good Shepherd Sisters of Quebec, an order founded in 1850 in Quebec, Canada, opened St. Andre in 1940 to help troubled women turn their lives around. It initially served as a home for unwed mothers.

“It was much more of an institution. There was no license needed to do what we did, and women came from all over the country,” Fitzpatrick says.

The home functioned essentially as a maternity hospital, where women gave birth and then put their children up for adoption.

Its role began to change in the 1970s, Fitzpatrick says, as American society grew more accepting of young, unwed mothers, and the need for services for such women grew. St. Andre eventually opened two group homes in Lewiston, Maine, and one each in Bangor, Maine, and Biddeford.

Over time, Fitzpatrick explains, there has been a “gradual switch from adoption to young women keeping their children and learning how to parent them, which is the main focus of St. Andre’s right now.”

Youth Served: The facilities house women ages 15 to 30, although most are no older than 19. The homes care for approximately 75 mothers and 50 babies each year. The homes accept only Maine residents.

Staff: Each home employs six full-time staff members. The staff typically includes a supervisor, a clinical social worker with a master’s degree, and four “group life workers,” who provide general support for the residents. Each has a background in social service, social science, counseling or education, and acts as “surrogate mother” to the residents, Fitzpatrick says.

Funding: Each home has an annual budget of between $365,000 and $450,000, and the average monthly cost per family is about $8,600.

Medicaid covers about two-thirds of the costs. Other funding comes from a mix of sources, including the Maine Department of Health and Human Services, United Way, Good Shepherds Sisters, religious organizations such as the Roman Catholic Diocese of Portland, and private donations. Residents who have income are supposed to pay one-fourth of that income to cover program costs.

Indicators of Success: The organization has not done a study of those who have been through the program.

Teen Tot Clinic

Hasbro Children’s Hospital
Providence, R.I.
(401) 444-5980

The Approach: Based in the Adolescent Health Care Center at Hasbro Children’s Hospital, this clinic provides social and medical services specifically for teen mothers and their newborns. The medical services include comprehensive primary care, such as gynecological exams, Pap smears and screening for sexually transmitted diseases for the mothers, and immunizations for the babies.

The clinic offers medical services to the young mothers and all of their children, as well as teen fathers, for five years after the birth of the child. The clinic supplements its medical services with a staff social worker, nutritionist and educational liaison.

“We teach them to advocate for themselves and their babies in the health care system so they are ready to deal with the traditional health care system on their own when they reach 21,” says Dr. Patricia Flanagan, supervisor of the clinic and director of the Adolescent Health Care Center.

At the same time, she says, the clinic’s youth workers push youth to stay connected with adults in their communities. “We work hard to keep kids in school and help them stay in a stable homes,” Flanagan says.

The objective is for the mothers to go to the clinic for up to five years, leaving with the knowledge of how to get proper care for themselves and their children in traditional health care facilities and programs.

History and Organization: Flanagan and Dr. Suzanne Riggs founded the clinic in 1986. “We were interested in the parallel development between the mother and her baby and what it really meant to be a mother at 14 and 15 years old,” Flanagan says.

Youth Served: Mothers must be 16 years old or younger at the time of the birth. The clinic serves nearly 300 families a year.

“Almost all of the children are poor,” Flanagan says. Most are on Ritecare, the Rhode Island managed-care Medicaid program, “which reflects the demographics of child-bearing school-aged moms.”

Families are referred primarily by the Teen Obstetric Clinic at Women and Infants Hospital, or newborn nurseries at Women and Infants Hospital of Rhode Island.

Staff: Flanagan’s staff includes a social worker, nurse practitioner and nurse. “We usually have a nutritionist and an educational liaison,” she says. “But we don’t right now, because we are between grants.” The clinic also uses the services of the hospital’s pediatric resident physicians.

Funding: The program has no separate budget.

The teen parents are charged for the services provided by the clinic. Flanagan says almost 90 percent of the youth are covered by Medicaid, while most others are covered by their family insurance.

The hospital provides the social worker. Grants have been provided by local organizations.

Indicators of Success: The clinic has not conducted a formal impact evaluation. Flanagan and her colleagues are evaluating the health resource utilization of teen mothers and their children, both in and out of the program.

“Our biggest success is a lot of excellent young mothers,” Flanagan says. “It’s always a success when you see a healthy mother and baby succeed.”