Pregnancy Assistance Fund grantees are changing the lives of pregnant and parenting young people around the nation. The PAF Resource and Training Center is pleased to present profiles of these ground-level change agents and highlights of the important work they are doing!
See highlights of current grantees:
- Michigan Department of Community Health
- Massachusetts Department of Public Health
- Montana Department of Public Health and Human Services
- Minnesota Department of Health Treasurer
- New Jersey Department of Children and Families
- North Carolina Department of Health and Human Services
- Connecticut State Department of Education
- Washington State Department of Health
- California Department of Public Health: Maternal, Child and Adolescent Health Division
- New Mexico Public Education Department
- Choctaw Nation of Oklahoma
- Oregon Department of Justice
See highlights of former grantees:
Spotlight On: Michigan Department of Community Health
Michigan Adolescent Pregnancy and Parenting Program (MI-APPP) serves expectant and parenting teens ages 15-19 in high-need communities across the state of Michigan. Supported with funding from the Office of Adolescent Health (OAH), the program was created to address teen parents’ low high school graduation rate and high repeat birth rate, the latter of which is associated with poor infant health and a lack of prenatal care., In particular, the program provides expectant and parenting teens with a strengths-based integrated system of care to reduce repeat pregnancies, strengthen access to and completion of secondary education, improve maternal and child health outcomes, and build familial connections and support networks.
MI-APPP operates in six sites across Michigan and implements the Adolescent Family Life Program-Positive Youth Development (AFLP-PYD) Case Management program, a model developed by the State of California. AFLP-PYD case managers meet with expectant and parenting teens twice a month to:
- assess their strengths and needs,
- develop an individualized service plan,
- promote health and safety practices, and
- refer teens to services that can improve the health of their young families.
Additionally, the case managers conduct home visits to help teen mothers and fathers strengthen their self-sufficiency and meet their educational and career goals. Positive youth development principles are used throughout the case management process, which help to identify protective factors in teens’ families, schools, and communities.
In addition to the case management program, each MI-APPP site selects supplemental resources to provide or leverage in their community to support expectant and parenting teens. In order to identify existing resources, each of the six communities underwent a four-month long needs assessment that included focus groups, key informant interviews, and a community resource inventory. Key findings across all sites include that:
- teens are motivated to complete their education, but may need accommodations;
- teens used multiple health care resources, but many did not access prenatal care;
- teens wanted to form more supportive relationships with key adults; and
- teens accessed many government and wellness resources, but needed more support for safe and stable housing, reliable transportation, and affordable child care.
Each community has used the results of their needs assessment to identify and fill gaps in resources or to tailor existing resources to better serve the needs of expectant and parenting teens. For example, some communities have started monthly classes on a variety of topics related to self-sufficiency, from financial literacy to co-parenting. One community has begun implementing facilitated conversations with fathers at barbershops where male participants and their children can get a haircut while discussing fatherhood topics.
Ultimately, MI-APPP feels that its strengths-based approach has been a key element of the program’s success. Positive youth development approaches have been infused throughout their case management and supplemental activities. Project Coordinator Hillary Turner noted, “Through our approach, the teen is the expert and the case manager provides support to help them leverage their resources and strengths through positive affirmation. By focusing on their strengths, not their deficits, and through motivational interviewing, we help them problem solve and make their own decisions. Through this we allow the teens’ voices to be heard. We value their input, drive, and understanding of how things work.”
1 Centers for Disease Control and Prevention. (2013). Preventing repeat teen births. Retrieved March 12, 2015, from http://www.cdc.gov/VitalSigns/pdf/2013-04-vitalsigns.pdf
2 Klerman, J. A. (2004). Another chance: preventing additional births to teen mothers. Washington, DC: The National Campaign to Prevent Teen Pregnancy.
Spotlight on: Massachusetts Department of Public Health (2014)
Massachusetts Pregnant and Parenting Teen Initiative (MPPTI) is a community-based program that serves expectant and parenting youth ages 14-24 in five cities across Massachusetts including Chelsea, New Bedford, Holyoke, Lawrence, and Springfield. The five communities identified for MPPTI experience a disproportionate burden of school dropout1, poverty2, and sexually transmitted diseases3 compared to the state as a whole.
In an effort to address these challenges, Massachusetts Department of Public Health implemented MPPTI to provide a comprehensive support model to help participants. Program goals are to (1) Increase academic achievement through individualized academic and career goals; (2) Improve reproductive health outcomes by delaying subsequent pregnancy; and (3) enhance family stability through increased connection with social and emotional support systems, improved self-sufficiency, and healthy parenting practices.
Estimated to reach approximately 1,000 families in the next four years, MPPTI offers an array of services to participants with a strength-based approach. Services include a weekly check-in with a youth worker who identifies specific needs of program participants and acts as a link with community resources, monthly or bimonthly meetings with an education or employment counselor, and individual or group counseling as needed. The program also offers health education and preventive screenings by an RN approximately every 6 months, and weekly or monthly pre and postnatal groups.
One of the successful components of MPPTI is the Digital Story Telling Project. The project involves developing digital stories to illustrate expectant and parenting youth’s transition into parenthood. The project not only empowers youth to share the challenges of adolescent parenthood, but also teaches youth without technical background to produce work that tells a story using moving images and sound. After the digital stories were recorded, MPTTI launched a digital storytelling event to showcase the stories to community members, program participants, state agencies, and other providers at a movie theater. The stories have also been used for training new MPPTI staff and in parenting groups with young parents. The following is an account from one of the participants.
Even with two children, my life was out of control. Parties, drugs, gangs, and just living that fast life. I thought that was it. I didn’t love myself and therefore I didn’t know how to love my children enough to make a change….it is not that I didn’t know the things I had to do, it is that I had no confidence, no dreams, and no inspiration. Things started to change when I got assigned to a youth worker. At first I put up a wall with her and ignored her calls countless times. But she never gave up. She did it all to help me work toward my GED. It felt good to have one person believe in me even though I kept falling off track. She and I begin to have a great friendship. Not just a youth worker-teen relationship. I attended the program and tried half the time just for her because she always gave me her time and attention. I attended nurturing programs to help me deal with my two beautiful daughters and the third that was on her way. I also attended “Circle” which allowed me to grow and be relieved from a dark past…my past lied to me. It made me believe I was nothing, had nothing, and was never going to be better. When it came to my GED, it was the giant obstacle that wouldn’t let me break out of that tiny miserable world….my GED teacher told me that I was worth way more than I believed—that I was smart and I could do it. I would sit there and say miserable things about myself and [my ability to do] math. But he would constantly fight the negative attitude with words of encouragement. He believed in me more than anyone, more than my mother, and that gave me strength. Once I pushed the negative aside, my brain became like a sponge. I thank God for my youth worker and GED teacher. I have obtained my GED—that is my stepping stone to be a better me. I am inspired, I want to go to college, I will go to college and be whatever I want to be.
MPPTI’s Program Coordinator reports that prior to the program many of their teen parents have never been asked about their strengths. Working with MPPTI program staff to identify their strengths has resulted in a feeling of empowerment and increased their desire to work toward attainment of their life goals. To show gratitude to the program that helped them find their voice, program participants have expressed wanting to give back to the program through peer leadership. MPPTI is hoping to implement this new component in the years to come.
MPPTI Program Coordinator
 Massachusetts Department of Elementary and Secondary Education. (2012). 2011-12 Indicators Report. Retrieved April 2, 2013 from http://profiles.doe.mass.edu/state_report/indicators.aspx,
 US Census Bureau. American Community Survey, 2007 – 2011, Selected economic characteristics. Retrieved April 9, 2013 from http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_11_5YR_DP03
 Massachusetts Department of Public Health. (2010). Sexually Transmitted Disease Program. Massachusetts Community Health Information Profile (MassCHIP), version 3.00 r327.
Spotlight on: Massachusetts Department of Public Health (2013)
Summary: The Massachusetts Pregnant and Parenting Teens Initiative (MPPTI) provides wraparound services (medial, social, emotional and community supports) to over 500 pregnant and parenting young people ages 14 through 24 in high schools and community centers. The services are located in five high-needs communities in Massachusetts: Chelsea, Holyoke, Lawrence, New Bedford, and Springfield. These communities all have teen birth rates roughly double the national average and between three and five times higher than the statewide average (Mass. Department of Public Health (2010), Births (Vital Records), MA Community Health Information Profile version 3.00 r327). Using funds from the Office of Adolescent Health’s Pregnancy Assistance Fund, the Massachusetts Department of Public Health contracted with community-based agencies in these communities to transform the lives of pregnant and parenting teens. MPPTI has three main goals:
- Achievement of educational and vocational goals,
- Delay subsequent pregnancy, and
- Improve infant health and development.
In order to meet these goals, MPPTI emphasizes social, emotional, and community support for pregnant and parenting young people. To provide such support, the program has adopted a strengths-based approach. Participants work with service providers to identify their educational, employment, and health goals and the barriers they perceive standing in their way to goal achievement. MPPTI service providers reported that many participants have never been asked to identify their strengths. Using this method of engagement, participants feel empowered and desire to work towards attaining their life goals.
In addition to identifying goals and barriers, service providers also assist pregnant and parenting teens by connecting them to resources that address their unique needs. For example, participants are often connected to mental health counseling, social support, childcare, transportation, housing, and/or health care. Each MPPTI location employs case managers, education liaisons, mental health counselors, and home-visiting nurses to assist in supporting and meeting the needs of young parents and their children. In order to maximize participation and help teens connect with their peer participants are offered a hot meal, childcare and transportation.
To learn about one participant’s success in the program, click the link to view her digital story: http://vimeo.com/68626408.
Lissette Gil-Sanchez, Coordinator
Massachusetts Pregnant and Parenting Teen Initiative
Massachusetts Department of Public Health
250 Washington Street 5th Floor
Boston, MA 02108
Spotlight on: Montana Department of Public Health and Human Services (2014)
Overcoming Geographical Barriers to Meet the Multifaceted Needs of Expectant and Parenting Adolescents in Montana
Developed in 2010, Healthy Montana Teen Parent Program was designed to improve the educational and health status of expectant and parenting adolescents and their children, with a specific focus on serving American Indian populations. Montana’s teen birth rate for American Indians is 80.9 per 1,000 women aged 15 – 19 compared to the national average of 36.1.1,2 Because Montana has a population density of 6.8 persons per square mile3 with very limited public transportation, accessing services can be challenging for expectant and parenting teens.
Reaching upwards of 500 teens and young adults across Montana (including several reservations), the goals of this school and community based program are to facilitate self-sufficiency of expectant and parenting adolescents, build their parenting capacity, encourage postsecondary education and preparedness for the workforce, and improve the healthy growth and development of their children. To address these goals, program contractors address educational needs of participants to attain either a GED or high school diploma, and address at least two of the following: case management; referral and linkages to prenatal care and reproductive health services; quality child care; nurturing, parenting, and life skills education; and father involvement and support strategies.
The program has implemented a range of successful retention strategies, including using male facilitators to encourage male involvement, flexibility in communication approaches (e.g., Skype, texting, Facebook), providing on-site child care, and having “veteran” program participants lead group meetings. The program’s Project Coordinator shared that the best retention strategy has been fostering trusting relationships between participants and the adults working with them. One program contractor noted, “We want to be the incentive.”
Healthy Montana Teen Parent Program has already begun to see promising results. Participants’ prenatal care utilization has increased from cohort one to cohort two and the program has successfully secured partnerships with organizations working to achieve similar goals. The program is working with the Montana Office of Public Instruction to help program contractors connect with their local high schools and GED programs so they can increase the program’s reach. The program is also partnering with Healthy Mothers, Healthy Babies of Montana to provide outreach and training in high need communities on text4Baby, the Period of PURPLE crying, breastfeeding, and the Safe Sleep for Baby Crib Program.
Healthy Montana Teen Parent Coordinator
1 Martin, J. A., Hamilton, B. E., Ventura, S. J., Osterman, M. J. K., & Mathews, T. J. (2013). Births: Final data for 2011. National Vital Statistics Reports 62(1). Hyattsville, MD: National Center for Health Statistics. Retrieved September 6, 2013, from http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_01.pdf
2 Montana Department of Public Health and Human Services. (2012). Montana teen birth and tregnancy teport 2012, trends in teen births: 2002 – 2011. Retrieved April 18, 2014, from http://www.dphhs.mt.gov/publichealth/wmh/documents/pregnancyreport.pdf
3 U.S. Census Bureau. (2010). Montana. Retrieved April 8, 2014, from http://quickfacts.census.gov/qfd/states/30000.html
Spotlight on: Montana Department of Public Health and Human Services (2013)
Summary: The Montana Department of Public Health and Human Services is implementing the Montana Healthy Teen Parents Project to provide support for pregnant and parenting teens in high schools and community service organizations across the state. Through the project, the Department is providing core services for pregnant and parenting teens, which include flexible schooling, case management, parenting and life skills education, and referrals and linkage to prenatal care and quality child care. In particular, this Project is undertaking an initiative to support young fathers. One of the Project’s goals is to increase father involvement, when appropriate, among participants by 10 percent.
Involving young fathers in the lives of their children can have positive effects on children’s well-being. For example, father-child contact is associated with better socio-emotional and academic functioning and children with more involved fathers experienced fewer behavioral problems and scored higher on reading achievement. (Howard, K. S., Burke Lefever, J. E., Borkowski, J.G., & Whitman , T. L. (2006). Fathers’ influence in the lives of children with adolescent mothers. Journal of Family Psychology, 20, 468- 476.) Although no data are available to provide a clear picture of the number of adolescent fathers in Montana, it is estimated that nearly one in 10 teen boys between the ages of 12 and 16 will become a teen father before the age of 20.
Several Healthy Teen Parents Projects across the state have hired male social workers experienced in working with at-risk boys, to help address the needs of young fathers. Across the state, approximately 84 young fathers received services during the last grant year. For example, the Flathead City-County Health Department in Kalispell (Flathead) hired a Father Support Specialist whose charge is to support fathers and help them understand their role during pregnancy and the early years of their child’s life. In addition to providing parenting information, the Specialist helps young fathers reflect on their own relationships with their fathers and determine what type of father they would like to be for their own children. The Specialist also works closely with schools and potential employers to help young fathers finish their education and identify employment opportunities.
Based on early results of this initiative, it seems that the Specialist’s relationship with the young fathers is an important component of the overall program. In a newsletter article, one Specialist wrote:
“I was a bit surprised by the response I got from each client. Prior to working with these fathers, I was of the opinion that teenage boys are incapable of such adult responsibilities and given the change would walk away. The image most see when talking about teen pregnancy is that of the teenage girl. The image for me has changed within the first few meetings. These young dads want to be involved and be an active parent in their child’s life. They just need help knowing what this looks like.”
Programs across the state are referring young fathers to support services, such as substance abuse programs, therapy, parenting education, supervised visitation, and adoption services. Some programs are encouraging increased contact when and where appropriate between young fathers and their children by providing calling cards and access to Skype. This opportunity is showing promise; for example, one young couple reported that this service made an important difference in their relationship and in the young father’s relationship with his child. The father was able to connect with his child by using the calling cards and by video chatting to regularly participate in his child’s nightly bedtime routine, through reading stories and singing songs.
Kelly Hart, Healthy Montana Teen Parent Coordinator=
Montana Department of Public Health and Human Services
Phone: (406) 329-1537
Spotlight on: Minnesota Department of Health Treasurer (2014)
Developed in 2010, the Minnesota Student Parent Support Initiative is a post-secondary educational program that offers support to expectant and parenting college students and their children in nine colleges and universities across Minnesota. The program was developed to address the unique challenges faced by this population, including high risk for drop out, unplanned pregnancies, unhealthy behaviors, and difficulties preparing for future careers. Specifically, the program established goals to help expectant and parenting students accomplish their post-secondary education goals at institutions of higher education, maintain positive health and well-being for themselves and their children, and increase the capacity of institutions of higher education for serving expectant and parenting teens and their children.
The program, which currently serves almost 2,000 student parents and their children, offers a wide range of resources, including emergency financial assistance for child care, utilities, food, and rent; parenting education classes; social support groups and health education classes (i.e. smoking cessation, family planning, healthy eating, etc.); and screening for students for intimate partner violence, depression, tobacco use, and alcohol. The program is customizable so that participants choose their level of participation based on their individual needs.
In addition to offering direct services to the students, some participating institutions of higher education advocate on behalf of students by assessing if the schools’ policies can be modified to meet the needs of this population. For example, they advocate for lactation rooms on campus and for excused absences when parents need to care for their sick children.
The program has made significant strides in its short existence. They have increased their recruitment on campuses by attending campus orientation events, appointing expectant and parenting students as mentors to new students, and working closely with professors and healthcare clinic staff to increase referrals to the program. Specifically, Winona State University’s branch of the program employed a unique strategy of partnering with its child care center to increase cross referral between the two programs and ensure that student parents are offered comprehensive support.
At a state level, the program has built partnerships with the Minnesota Department of Human Services and the Minnesota Department of Employment and Economic Development to recruit future prospective students who are enrolled in job-training programs or the Temporary Assistance for Needy Families program.
Elizabeth A. Gardner, M.A.
Minnesota Department of Health
Community and Family Health Division
Spotlight on: Minnesota Department of Health Treasurer (2013)
Summary: Since 1993, St. Catherine University in Minnesota has been operating the Access and Success program, an innovative retention program focused on supporting student parents. Program staff are licensed social workers who assist students in building professional relationships and connect students to internal and external resources to meet their needs and the needs of their families.
The program identified some unique challenges and risk factors for this population: limited emotional and financial support, limited experiences navigating college life, and first generation college students frequently raised in single-parent homes. Nationally, fewer than two percent of student mothers complete a college degree by age 30. At St. Catherine’s, this population of mothers in the traditional baccalaureate program had a retention rate at least 10 percent lower than other student parent groups.
Using its Office of Adolescent Health funding, Access and Success piloted Steps to Success, a program aimed at improving the academic success of these young, at-risk student mothers. The pilot goals focus on academic success, financial stability, social connectedness, physical and emotional health, and leadership development. To participate, interested students were required to complete an application process. In 2009, eight low-income, single parent students between the ages of 17-22, in their first or second year of college, were selected to participate in the pilot. Due to the success of the program efforts, eight additional mothers were added to the program in 2012.
The program is tailored to help meet the unique needs of young student mothers in four ways:
- Bi-weekly meetings. Students learn practical information about parenting, finances, studying techniques, and balancing their complex roles as students, parents, and employees. Students are taught how to manage the expectations of academia, including how and when to approach their professors. They also attend small group presentations on topics such as stress management and sleep to support their physical and mental health.
- Leadership training. Students must complete a leadership component as part of the Steps to Success program. They can fulfill this requirement by volunteering in Mother-to Mother, a program where they share their personal story with high school teen parents, encouraging them to continue their education. Participants can also fulfill the requirement through involvement in campus student government, speaking to state government officials about the needs of student parents, or leading a lunch meeting for other student parents. This requirement helps students build confidence and autonomy, skills that benefit them in the classroom and beyond.
- Referrals to appropriate resources. Program staff refer students to resources they need, both on and off campus, such as assistance with custody proceedings and securing child support.
- Annual stipend for non-tuition expenses. Balancing the multiple demands as both students and parents, many of the mothers would not be able to complete program requirements without the $1,350 stipend as an incentive.
Efforts have been made to demonstrate the effectiveness of the initial pilot program. Within the University, the retention rate of program participants was consistently higher than those of a comparison group of student parents with similar demographics and academic levels. Also, the grades of those students participating in the program were higher than those of the comparison group, with participating students less likely to receive a C- or lower in their classes. Students participating in the program were also more likely to complete individual courses; only seven participants withdrew from a course compared to 11 in the comparison group.
Elizabeth A. Gardner, MA
Minnesota Department of Health
Community and Family Health Division
Maternal and Child Health Section
Student Parent Grant Coordinator
Phone: (651) 201-5411
Joan Demeules, LSW, MA
St. Catherine University
Associate Director, Counseling and Student Development
Director, Access and Success Program
Phone: (651) 690-7870
Spotlight on: New Jersey Department of Children and Families
The Parent Linking Program (PLP) is a program offered through Promoting Success for Expectant & Parenting Teens New Jersey (PSNJ). PSNJ has partnered with the New Jersey Department of Children and Families to identify additional PLP sites funded through the New Jersey School-Based Youth Services Program (SBYSP) which serves expectant and parenting teens and their children (6 weeks – 36 months of age) enrolled in 10 of the 67 high school program sites across New Jersey. Established in 1980, PLP was developed to reduce the barriers that impede the ability of expectant and parenting teens to complete their education, reduce the likelihood of repeated teen pregnancies, increase parenting skills to prevent child abuse and neglect, strengthen young father involvement and understanding of co-parenting responsibilities, and decrease intimate partner violence.
As a part of the PSNJ project, PLP offers an array of services to meet the needs of expectant and parenting teens. A critical component of the program is offering intensive case management services to connect expectant and parenting teens to coordinated comprehensive services that meet their ongoing needs. Furthermore, the program offers prevention oriented counseling, support, and education services to help parenting teens cope with daily living. Additional services include prenatal education and parenting skill building, which are designed to help parents reach their highest potential including, experiencing healthy births, preparing for family life, and meeting the responsibilities of school and parenthood. The program also offers childcare for a subset of enrolled teens on high school grounds or within a mile of the high school. The child care center is designed to be a safe, healthy learning environment designed to promote healthy child development through relationship building and a range of healthy child development activities.
Although the PSNJ project is in its first funding year, PLP has already made great strides. All of the sites have extended services from 10 to 12 months so that, for the first time, summer services will be offered to participants. With this expansion of services, there is no longer a waiting list for expectant and parenting teens and the program expects to reach 500 participants this year. Several programs have already seen an increase in enrollment of young fathers who are actively engaged and receiving services that are targeted specifically for them.
To help scale up for the expansion, the program has implemented monthly conference calls/webinars for program staff. The conference calls/webinars are focused on specific programming topics, such as case management, father engagement, and program implementation.
Additionally, the program has forged collaborations with several state and community agencies, including the New Jersey Department of Human Services, Department of Health, Department of Children and Families offices of Early Childhood Services and Education, New Jersey Department of Education, and Prevent Child Abuse New Jersey. New Jersey Department of Children and Families is hopeful that these partnerships will continue to help expand and enhance the effectiveness of PLP’s capacity and sustainability in the years to come.
Spotlight on: North Carolina Division of Public Health, Women's Health Branch (2014)
Young Families Connect (YFC): Engaging Communities serves expectant and parenting teens and young adults in five counties across North Carolina including Bladen, Onslow, Rockingham, Robeson, and Wayne. Originally called Young Moms Connect, the Women’s Branch of the North Carolina Division of Public Health expanded the program this funding year to engage and provide services to young fathers. The program was initially developed to address relatively high (compared to the state rate) infant mortality rates in the funded counties as well as teen pregnancy and repeat teen pregnancy rates that were higher than the state rate.1 Furthermore, the rate of child maltreatment was greater than the state rate in four of the five counties in 2010, with Onslow County having a rate twice as high as the state’s.2 The program expanded to serve young fathers in part because compared to women, men ages 18-24 are less likely to have a postsecondary degree and the employment rate for men is lower than the state rate in all five counties.3 Further, adolescent fathers earn less annually than those who delay fathering and are therefore not as prepared to contribute financially to the well-being of their children; low socioeconomic status has been tied with many risk factors for children including poor nutrition and low-quality child care.4,5
Designed to increase self-sufficiency, improve health and wellness, and improve parenting skills among expectant and parenting young women and men, YFC offers a range of services for expectant and parenting families. These services include providing financial assistance to complete the General Education Development (GED) test or facilitating continuing education at a community college or technical program. In addition, assistance is provided to help with securing employment, reducing child care costs, and providing transportation services to those obtaining a GED or enrolled in a community college. The program’s health and wellness services include financial support with medical services, health and wellness training, and domestic violence prevention workshops.
The Women’s Branch of the North Carolina Division of Public Health experienced impressive results with Young Moms Connect, including a 36 percent increase in home-based visiting participants who enrolled in a continuing education program or who are employed, and a 4 percent increase in high school graduation rates in the funded counties. Though the Division just began implementing the expanded version of the program for expectant and parenting men in February of this year, they are hopeful that with promising strategies, they will see equally notable results. Such strategies include using social media and public education channels to reduce barriers to existing services and promote healthy behaviors, as well as partnering with local health departments, social service agencies, lay outreach workers, faith-based communities, and domestic violence agencies to enhance systems of care to better help young parents become self-sufficient. This involves improving coordination of care and ensuring that providers understand the needs of expectant and parenting teens. Additionally, the program will implement a community-based needs assessment to identify community-specific support services for each county.
1 North Carolina Department of Health and Human Services. (2012). Raleigh, NC: North Carolina State Center for Health Statistics.
2 Duncan, D. F., Kum, H. C., Flair, K. A., Stewart, C. J., Vaughn, J., Bauer, R., et al. (2014). Management assistance for child welfare, work first, and food & nutrition services in North Carolina: University of North Carolina at Chapel Hill Jordan Institute for Families.
3 U.S. Census Bureau. (2011). American Communty Survey. Washington, DC.
4 Center for Mental Health in Schools at UCLA. (2008). Teen pregnancy prevention and support. Los Angeles, CA. Retrieved July 24, 2014, from http://smhp.psych.ucla.edu/pdfdocs/teenpreg/teenpreg.pdf
5 Child Trends. (2012). Children in Poverty. Washington, DC: Child Trends.
Spotlight on: North Carolina Department of Health and Human Services (2013)
Summary: The Young Moms Connect (YMC) program provides services to over 1,000 pregnant/parenting women ages 13-24 in five counties. According to the 2012 County Health Rankings, the percent of uninsured citizens in the five YMC counties was almost double that of the national benchmark of 11%. The NC State Center for Health Statistics reported three of the five YMC counties in the top 50 counties (of 100 counties) for teen pregnancy rates in 2011. The Young Moms Connect program also promotes six maternal health best practices in the YMC counties and throughout the state through training, public information and education activities. These best practices are: 1) reproductive life planning, 2) smoking cessation using the 5A’s counseling method, 3) promotion of healthy weight, 4) early entry and adequate utilization of prenatal care, 5) domestic violence prevention, and 6) utilization of medical homes for non-pregnant women.
Using funds from the Office of Adolescent Health Pregnancy Assistance Fund, the North Carolina Division of Public Health/Women’s Health Branch partners with many state and local agencies, including the North Carolina Healthy Start Foundation (NCHSF) to implement the YMC program. Their partnership with the NCHSF allows for broad distribution of critical health information to pregnant and parenting young women. Using social marketing and media outreach, pregnant and parenting women between the ages of 13-24 receive health and safety information/resources for themselves or their child(ren) related to the six maternal health best practices mentioned above. The following methods are being used to communicate this valuable information:
- The YMC website was launched in June of 2011 following several months of testing and focus groups. The easy-to-use design is aimed at attracting and engaging young women between the ages of 13 and 24. The website, www.YoungMomsConnect.org, received 9,322 total inclusive page views, 5,860 of which were unique page views, from August 2011-August 2012.
- The YMC “TextMOMS” texting service created a two way communications channel with young moms in the five counties. Each text was followed up with information about local resources. Radio ads promoting the “TextMOMS” texting service aired in five markets from June 2012-August 2012 with a total of 406,700 estimated viewers. All ads aired for an average of eight weeks. From August 2011-September 2012, Text MOMS received 816 text inquiries from 155 individuals. The questions were primarily related to prenatal care, breast feeding, parenting, birth control and healthy relationships.
- Three television ads for the YMC program were also created: an ad for the free text service “Text4Baby,” “Be the Better You,” and “Make a Plan.” The “Be the Better You” ad focused on healthy choices for pregnant and parenting young mothers, including nutrition, smoking cessation, and physical activity. The “Make a Plan” ad focused on reproductive life planning. The television ad for Text4Baby aired spring and summer of 2012 in six markets on seven stations, with a total of 1,255,603 estimated viewers. This contributed to the increase of new enrollees in the Text4Baby texting service from North Carolina. A total of 9,949 new North Carolina participants enrolled during the time period ads were advertised . The “Be the Better You” television ad aired in three markets on four stations for the period of April 2012-May 2012. The estimated viewing audience was not determined for this period. All ads aired for an average of four weeks. The “Make a Plan” television ad aired from June 2012-August 2012 in seven markets on six stations, with an estimated viewing audience of 1,014,028. All ads aired for an average of four-nine weeks, targeting women ages 12-24 years of age. Additionally, “Make a Plan” was evaluated in August 2012 by a leading provider of full-service research, custom online panels, online communities, and data collection services.
A web-based survey was conducted among North Carolina females ages 15 to 24 to evaluate the “Make a Plan” television ad. The pre-advertisement exposure results indicate that three-quarters of the target group (females in NC ages 15-24) had heard of a reproductive life plan and four out of ten remembered seeing, or think they may have seen, the television ad. The post-advertisement exposure indicated that the two main messages received from the television ad include planning and choices/decisions. The message of the TV ad was understood, with nearly all (95%) agreeing that having a reproductive life/life plan is a good idea. Overall, young women felt the television ad did a good job relating to its target audience, with nearly three-quarters reporting that they somewhat relate to the people in the ad. Additionally, www.YoungMomsConnect.org won the 2012 Grand Prize for websites developed by nonprofit agencies at the 24th Annual Awards for Publications Excellence (APEX) competition.
Tanya Bass, Program Coordinator
NC Division of Public Health Women’s Health Branch
Phone: (919) 707-5683
Lolita Smith Moore, Education and Outreach Coordinator, Young Moms Connect
NC Division of Public Health Women’s Health Branch
Phone: (919) 828-1819
Spotlight on: Connecticut State Department of Education (2014)
Offering Comprehensive Services to Support Expectant and Parenting Teens and Their Children in Connecticut
Supports for Pregnant and Parenting Teens (SPPT) is a school-based program that serves expectant and parenting teens and their children in six cities in Connecticut. Not only is poverty in these communities twice as high as in the rest of the state, but 52% of all teen births in Connecticut occurs in the cities served by the SPPT program. 1,2 Consequently, teens in these communities face a myriad of hardships including poverty, exposure to trauma, homelessness, repeat pregnancy, and truancy.
In an effort to address these challenges, SPPT was designed to improve the education, health, and social outcomes for these teen parents, as well as to promote the healthy development of their children. Investing in the long-term well-being of this population, SPPT strives to build the capacity of these communities to provide and sustain supports for families beyond federal funding.
Staffed with a social worker and nurse, the program comprised of a host of services including academic support, prenatal care, child care, parenting and life skills education, individual and group counseling, case management, service referral, and home visits. Participants have access to the program five days a week when school is in session, and the social worker is on call 24 hours a day for emergencies.
SPPT has employed a wide array of strategies to engage and retain their participants. Strategies for reaching attendance goals range from daily contact with participants through texting, phone calls, and home visits to providing incentives, such as car seats and high chairs. They have also offered unique opportunities such as a summer workforce development program with paid employment.
SPPT’s hard work has paid off and they have already begun seeing positive changes. In year two of program implementation, of the 263 particpants and their children, 99% of children in the program were up-to-date on their well-child visits, 77% of participants graduated or remained in school, and the prevalence of repeat pregnancy rate was down to less than 2%. But the impact of the program extends beyond just the statistics; participants report the significance of the program in their lives. One participant notes, “The program is very helpful for me and my young family. I feel like this is my family apart from relatives at home. There was so much help during my pregnancy and after that I can honestly say that with the support, I have so much motivation towards finishing school and making a great life for my daughter."
1 Connecticut Conference of Municipalities. (2010). A tale of disproportionate burden: The special needs of Connecticut’s poorer cities. New Haven, CT. Retrieved April 2, 2014, from http://hartfordinfo.org/issues/wsd/taxes/ccm-poorer-cities.pdf
2 Connecticut Department of Public Health. (2012). Vital Statistics: Connecticut Resident Births 2010- births to teenagers, low birth weight births and prenatal care for county, health district and town by mothers race and Hispanic ethnicity (Table). Hartford, CT. Retrieved April 2, 2014, from http://www.ct.gov/dph/cwp/view.asp?a=3132&q=394598
Spotlight on: Connecticut State Department of Education (2013)
Summary: Pregnant and parenting teens are now on track for graduation from high school in some Connecticut schools because of the critical supportive services from the Support for Pregnant and Parenting Teens (SPPT) Initiative. This initiative is funded through a grant from the Office of Adolescent Health. Analyses of Connecticut data show high correlation between teen births and school dropout rates. In five Connecticut cities, the teen birth rate was at least two times greater than the overall state rate.
The SPPT Initiative helps school districts in those five cities, Bridgeport, Hartford, New Britain, New Haven and Waterbury, develop comprehensive programs that improve the health, education, and social outcomes for pregnant and parenting teens and their children. This model offers:
- Flexible, quality schooling to help young parents complete high school
- Case management and family support
- Linkages and referrals to prenatal, reproductive, and pediatric health services
- Quality child care and transportation services
- Parenting and life skills education and support services, including home visiting through a partnership with Nurturing Family Network programs
- Fatherhood involvement services and supports
All services take place on a scheduled basis during lunch, study halls, and before/after school. Dedicated space has been identified in a comprehensive high school in each city where teens can drop in during lunch, study hall or between classes for healthy snacks, to rest, or see the nurse or social worker with quick questions.
Monthly data reports track school and daycare attendance and participation. Year Two outcomes point to strengths of the program. These strengths include:
- Eighty percent of seniors enrolled in the program are graduating or remaining in school
- Ninety-eight percent of the students are receiving three or more of the comprehensive service components
- Ninety-eight percent of the children are up-to-date on their immunizations and well-child visits
- Ninety-nine percent of the children are meeting developmental milestones or receiving appropriate services to address developmental delays
In Year Two of the Initiative, 273 students were served (92 teen mothers, 142 pregnant teens, and 39 teen dads). The SPPT Initiative continues through August 2013. The Connecticut State Department of Education (CSDE) is working with sites to conduct sustainability assessments and develop sustainability plans.
Additionally, the Hispanic Health Council (HHC) has used the inventory of existing resources to expand their website to include a page specifically for pregnant and parenting teens: http://www.hispanichealthcouncil.org; http://www.hispanichealth.com/hhc/ctteenparent.
Title: Project Director
Organization: Connecticut State Department of Education
Phone: (860) 807-2103
Title: Project Manager
Organization: Connecticut State Department of Education
Phone: (860) 807-2070
Spotlight On: Washington State Department of Health
Developing sustainable local systems, changes in policy and practice, and providing training and information improves access to resources and services for pregnant and parenting teens and women
Summary: The Washington State Department of Health (DOH) partners with multiple entities to create a strong collaborative model that supports pregnant and parenting teens and women statewide. Washington DOH engages the Office of the Superintendent for Public Instruction (OSPI), ten local health jurisdictions, the Attorney General’s Office (AGO), and Within Reach (a community-based organization) to take a comprehensive approach to address the needs of the community. Each of these primary partners works within their own arenas to build collaborations. Each partner also cross-collaborates with one another to ensure that the support being offered to pregnant and parenting teens and women is multidisciplinary in nature.
Over the past few years a significant number of Graduation, Reality, and Dual-role Skills (GRADS) teachers in Washington State retired, which left a large void to be filled. Since few teachers have experience teaching pregnant and parenting teens, the void that developed had the potential of collapsing the support for many pregnant and parenting teens. As part of this grant, OSPI provides increased teacher training and support to the GRADS programs, which are in-school, secondary programs for pregnant students and young parents, both male and female. The trainings provided confidence and tools to the new teachers and ensured continuous, skilled support for the pregnant and parenting students.
The GRADS teachers and students also receive support from their respective communities due to the grant and the collaborative work between DOH, OSPI and Local Health Jurisdictions (LHJ). Each of the ten identified LHJs created stakeholder groups that meet on a regular basis. These stakeholder groups are comprised of representatives from a variety of disciplines. Through the partnerships with these stakeholders, the local health jurisdictions have been able to identify resources and gaps in services related to pregnant and parenting teens. These resources have helped to support the in-school GRADS programs and the youth who attend. One local health jurisdiction (Snohomish County) has created a blueprint that provides a framework for the supportive services needed for this population. All of the stakeholders are committed to this blueprint and to ensuring that the work outlined in it is accomplished, even after the grant funds end. LHJs are also reaching out to pregnant and parenting teens that have dropped out of school to identify specific barriers that keep them from re-enrolling. The LHJs will work with stakeholders to address the barriers that can be resolved with local solutions. Multiple grant partners will engage the appropriate state agencies to begin addressing those barriers related to state program policies and processes.
Through cross-disciplinary partnerships, the AGO partners with two state-wide coalitions to address intimate partner violence and sexual assault. These efforts have resulted in the development of cross-disciplinary practice guidelines for screening for domestic violence, sexual assault, and stalking with pregnant and newly parenting women and teens. The disciplines covered in the practice guidelines are health care providers, domestic violence and sexual assault advocates, law enforcement, and prosecutors. Three communities throughout Washington are piloting the practice guidelines and are being evaluated to identify key lessons learned that will help others who want to use this tool. Through the development and demonstration process, several Washington State communities began new dialogue and relationships with community partners centered on the much-needed services for pregnant, parenting women, and teens.
WithinReach, a statewide nonprofit, has connected Washington State families to health information and resources for many years, but had never focused on the teen parent population specifically. Recently, WithinReach developed a new teen-focused website and public awareness campaign through this grant. The website, WashingTeenHelp.org, was developed with input directly from teens and providers, including GRADS students and instructors. The site also links to the resources identified through each of the ten targeted local health jurisdictions. This year, WithinReach is planning to pilot a text message component to the website. Currently, the State Maternal and Child Health hotline is connected to the site. In order to better serve teens, the call centers will communicate via text messaging to answer questions and link youth to needed resources.
Title: Project Manager
Organization: Washington State Department of Health
Spotlight on: California Department of Public Health, Maternal, Child and Adolescent Health (2014)
Adolescent Family Life Program Positive Youth Development (AFLP PYD) is an evidence-informed, standardized case management program designed to serve expectant and parenting teens that either have custody of a child or are co-parenting with a custodial parent. Youth in the program face an array of challenges including poverty, unstable home environments, domestic violence, academic struggles, substance abuse, mental health issues, and juvenile justice involvement. The program uses a positive youth development resiliency framework and life planning support with the goals of reducing repeat teen pregnancies, and increasing educational or vocational advancement, parent and child health, and linkages and supports.
Expected to reach an estimated 2,600 expectant and parenting teens across 26 counties in California, AFLP PYD empowers youth to pursue life goals that will improve the health and well being of themselves and their children. Youth in the program receive two in-person visits per month with their case manager who promotes resilience by helping youth form caring relationships, maintain high expectations, and identify opportunities for participation and contribution. Additionally, case managers help youth develop problem solving skills and a sense of purpose, as well as increase autonomy and social competence.
The California Department of Public Health, Maternal, Child and Adolescent Health (MCAH) made great strides with a formative evaluation of the AFLP PYD pilot that helped determine that the program's components, tools, and training are appropriate and effective. MCAH will expand implementation to additional sites and plans to conduct a rigorous evaluation to build the evidence base for the program.
In addition to solidifying the design of the intervention, California's AFLP PYD program has positively affected the lives of many expectant and parenting teens. One youth in the program who was recently released from a juvenile facility shared that through AFLP PYD she has learned to draw from her strengths and now feels confident in her ability to provide a better future for herself and her daughter. She remarked, "This program has taught me to be patient and to set goals. Little by little you can make things happen. It has helped me out a lot. Before this I never looked forward to meeting with a case worker, but I look forward to [her] visits. I learned to appreciate the help of others. I never thought I could do it, but here I am taking care of business. I didn't think I could go from where I was to thinking about careers."
AFLP PYD Coordinator
Print the full success story here.
Spotlight On: California Department of Public Health: Maternal, Child and Adolescent Health Division (2013)
Summary: The California Department of Public Health’s Maternal, Child, and Adolescent Health Division (CDPH MCAH) is developing a life planning intervention for case managers to use with the Adolescent Family Life Program (AFLP) pregnant and parenting teen clients. A life planning intervention supports preconception and interconception health as a critical component of reproductive health and may improve pregnancy-related outcomes and reduce disparities in adverse pregnancy outcomes. The life planning intervention includes a life planning tool called My Life Plan (MLP) for use with case managers and a group level intervention (GLI).
CDPH MCAH partnered with Sacramento County’s Sutter Health’s AFLP to further develop a case management life planning tool called MLP that was initially created by Sutter Health using March of Dimes funding. The MLP is an interactive, client centered, strength based tool in which clients work on life planning modules with the support and guidance of their case managers. It is designed to help clients create a plan, based on their own strengths and values, and set personal goals to improve their health and well-being, and that of their child/children.
The theoretical construct of the tool is positive youth development (PYD). PYD is an affirming and prevention-based approach to working with youth that aims to develop their resiliency by strengthening developmental assets such as social competence, problem solving, autonomy, and sense of purpose. PYD is a counterpoint to deficiency models that focus on youth problems and reducing risk behaviors. The PYD focus of this life planning intervention led CDPH MCAH to designate this project AFLP PYD.
The MLP tool consists of the following modules:
- Me and My Life
- Taking Care of Me – The Skin I’m In
- Taking Care of My Baby
- Reproductive Health and Safe Sex
- Healthy Relationships
- Education, Career, and Money
Clients begin with the Me and My Life Module. This module guides clients through a process of reflection on their personal strengths, values, and their dreams and goals for the future. The tool begins with this module because it introduces clients to the importance of talking about their goals, thus preparing and empowering them for all future work on the MLP. Once the Me and My Life Module is completed, the use of, order, and duration of the remaining modules depends on the individual needs of clients and the duration of their enrollment in AFLP. As a client works through each module, a form called the My Goal Sheet is used by the client to plan their steps and timelines for reaching the specific personal goals they have set in relation to the module. In order to ensure the AFLP program goals are effectively addressed while using this client-centered tool, during every visit, regardless of which module the client is working on, the case manager briefly checks-in with the client on the four AFLP program priority areas: contraceptive use & empowerment, education, healthy relationships, and access to health care.
The eleven AFLP PYD agencies began their grant experience with a capacity building year. Grantee staff received a series of trainings including: core competencies for providers of adolescent sexual and reproductive health (for supervisors); positive youth development; case management and motivational interviewing; and life planning. The series of trainings culminated in a final “pulling it all together” training that included the theoretical constructs and skill-building on application of the MLP for 61 AFLP supervisors and case managers. Local sites are currently practicing use of the tool and will begin using the MLP with all AFLP clients in January 2013. It is projected that 975 pregnant and parenting teens will receive the intervention monthly.
In addition to developing the MLP tool for case management, CDPH MCAH also partnered with the developers of Positive Prevention Plus to explore use of a Group Level Intervention (GLI) for AFLP. Positive Prevention PLUS is specifically tailored for pregnant and parenting teens and is based on the research-validated curriculum, Positive Prevention HIV/STD Prevention Education for California Youth, the most commonly used HIV/STD prevention curriculum in California. The eight session, Positive Prevention Plus curriculum, which directly aligns with the AFLP goals, is being evaluated to assess its success in supporting MLP outcomes. Four AFLP sites are piloting the GLI.
The University of California, San Francisco will guide a formative evaluation of the MLP case management intervention and the GLI. Evaluation will include surveys, focus groups, and key informant interviews with supervisors, case managers, and pregnant and parenting teens. The goal is to synthesize the formative feedback from local partners to refine the case management tool and integrated usage of the GLI, and ultimately to develop a standardized intervention based on a full pilot evaluation for AFLP case management in California.
Title: Project Coordinator
Organization: California Department of Public health
Phone: (916) 650-0381
Spotlight on: New Mexico Public Education Department (2014)
Expectant and parenting teens face a range of challenges such as juggling multiple roles without co-parent support, poverty, risk of dropping out of school, behavioral health issues, and homelessness. Serving 26 sites across New Mexico, New Mexico’s Graduation Reality and Dual-role Skills: Making Connections for Success (NM GRADS) is a school-based program for expectant and parenting teens that aims to address these challenges. The program encourages teen parents to stay in school, access needed services, become self-sufficient, graduate, and pursue postsecondary opportunities or employment. NM GRADS includes a host of services such as a for-credit class using 10 GRADS+ competencies, case management, home visitation, peer education, and on-site child care in 19 sites. New components of the program include supporting young fathers, college and career readiness, and early childhood/infant mental health.
NM GRADS reaches approximately 500-700 expectant and parenting teens each year and has experienced many exciting successes. GRADS Career Academies, which is comprised of inspirational speakers and opportunities to meet with career advisors, has helped expectant and parenting students realize their career interests, career pathways, and available postsecondary options. Additionally, ten NM GRADS sites are utilizing on-site mentors to meet the needs of young fathers, and the program developed an iPad-based questionnaire to identify the unique needs of NM GRADS students.
The New Mexico Public Education Department also partners with the New Mexico Attorney General’s Office (NMAGO) to increase awareness about healthy relationships and teen dating violence through a statewide teen dating violence program. Approximately 2,000 youth, including NM GRADS students, receive teen dating violence presentations each year. As part of this effort, youth-led teen dating violence campaigns were launched in four school districts to increase the capacity of students, schools, and communities to prevent, recognize, and respond to teen dating violence.
In addition to NMAGO, the GRADS+ initiative has developed a number of strong state and local partnerships, including partnerships with the New Mexico Department of Health, New Mexico Alliance for School-Based Health Care, New Mexico Forum for Youth and Community, school districts, school-based health centers, workforce partners, and early childhood programs.
NM GRADS has made a profound impact on hundreds of expectant and parenting teens. One of the GRADS programs shared a story of one student for whom the program made all the difference:
Rhonda has a two-year old daughter who is frequently ill due to her premature birth. Last school year, Rhonda was on the verge of dropping out. Her grades were low and she had many absences. The GRADS+ Teen Support Specialist (TSS) and teacher developed a strong, supportive relationship with her. They encouraged her to stay in school and worked with her to bring up her grades. The TSS also worked with teachers, counselors and school administrators to advocate for her. Rhonda is now a senior at her high school and is currently on the honor roll. The TSS helped arrange for her to take online courses so that she could stay on track academically despite numerous absences. Rhonda is planning to attend college after high school at New Mexico State University and wants to become an ultrasound technician. Rhonda is proud to be a mother and says her daughter is her heart, soul, and motivation.
Expectant and Parenting Teen Program Coordinator
Spotlight On: New Mexico Public Education Department (2013)
Summary: The Las Cruces High School GRADS team in Las Cruces, NM has long realized the need our teen parents have for additional emotional and mental support. They know that if the teens are not healthy emotionally and mentally, they cannot provide that same support for their children. One of their goals with the GRADS+ grant is to implement one-on-one conferences with their teen parents to address not only personal issues but parenting issues as well. Their Child Development Center Director is participating in training to become endorsed in the area of Infant Mental Health, which offers education about how to conduct these one-on-one conferences in a supportive way that allows the teen parents to identify strengths and problem solve challenges. Along with this training, she has implemented conferences with the teen parents to address personal relationship problems, as well as issues related to being a teen parent (accessing housing, financial assistance, nutrition and breastfeeding support, etc.) and building positive, nurturing relationships with their young children. She has begun offering assessments of children for parents. She first videotapes children as they engage in activities, then reviews the video with the parents so the parents understand the value of play-based learning and positive relationships. Eventually the children will be videotaped interacting with their parents. Conferences will be set up again so conversations about strengths and challenges can be addressed. By utilizing these strategies they have been able to solve serious issues between several of the teen parents, help a parent identify and problem solve some issues with discipline and have increased conversations about issues individual teen parents are facing. Additionally, they have started a tutoring program to help teen parents who are struggling in classes..
Title: Child Development Center Director
Organization: New Mexico Public Education Department
Phone: 575-527-9400 Ext. 6771
Spotlight On: Choctaw Nation of Oklahoma
The Choctaw Nation of Oklahoma is a federally recognized Indian Tribe, providing services to a Native American population in a vast, extremely rural, and economically deprived area that has many challenges. Two such challenges are access to services and service delivery. For example, many members of the Tribe must travel two hours to access health services, including childbirth services. In addition, jobs within the Nation are scarce. The Kids Count Factbook (KCF) indicated that 43 percent of Native American children in Oklahoma live in households in which neither parent has full-time employment. The Bureau of Indian Affairs (BIA) released data showing an unemployment rate for Choctaw tribal members at 36 percent. In 2009, the Oklahoma State Department of Health (OSDH) also reported that the Choctaw Nation had 72.6 teen births per 1,000 females, compared with 63.6 across the state.
According to the OSDH and KCF 2008, the highest rates of low birth weight, infant mortality, child abuse and neglect, and child and teen death are in the Choctaw Nation. The Choctaw Women, Infants, and Children (WIC) program reported that 46 percent of participating children are being raised by grandparents, typically because parents are unable to care for them due to incarceration, substance abuse, or abusive domestic situations.
The goal of the Choctaw Support for Pregnant and Parenting Teen (SPPT) project is to improve the health, education, and social service outcomes for pregnant and parenting teens and their babies. SPPT strives to meet its goal by providing comprehensive, medically appropriate services to participants, including linkages with critical resources, ongoing support for health and educational achievement, and evidenced-based positive parenting and relationship skills instruction using a nationally-validated model. During SPPT’s grant funding cycle, over 110 families (an average of three people per family – for a total of over 330 people) were served for a minimum six-month period. The SPPT program is a 24-month program. Over 48 families complete the entire program, with several more families close to their completion date.
Twice a month, clients receive the Parents as Teachers (PAT) evidenced-based curriculum. The curriculum’s core components include child development education, parent-child interaction activities, and family well-being discussions. Using the curriculum, the support specialist engages the entire family unit and identifies resources that will assist them in meeting individual and family goals. Clients also have the opportunity to participate in monthly group meetings that combine the core components of the PAT curriculum with Choctaw specific cultural activities. At each group meeting, fathers or male role-models also have the opportunity to participate in male-only sessions with a Fatherhood Counselor, focused on helping them improve communication, relationships, and parenting skills.
Each family receives a variety of assessments including post-natal depression, child development, parent knowledge, home safety, and immunization status of each child. Goals are set and re-evaluated at each visit until they have been met or are no longer desired by the family. The support specialists also document each referral until the service is received by the family.
The positive impact of SPPT can be illustrated through the story of one young couple with insufficient housing, very little income, and expecting their first child. Through the SPPT program and monthly home visits, the support specialist was able to connect the family with services and provide parenting education. The couple experienced a healthy birth, now has stable housing, a car, a connection with a doctor, and is pursuing admittance to a GED program and a job training class. The mother credits the SPPT program with helping the family move towards their goals.
Spotlight On: Oregon Department of Justice
Improving Pregnant and Newly Parenting Women’s Safety and Well-Being by Increasing Access to Intimate Partner Violence Advocacy Services
Intimate partner violence (IPV) is a critical problem for pregnant and newly parenting women. Nearly one third (31%) of Oregon women aged 20-25 who were surveyed in 2004 reported that they had experienced one or more types of violent victimization, including threats of violence, physical assaults, sexual assaults or stalking.[i] In 2007, 16.3% of Oregon women reported that at some time during their life someone had had sex with them against their will or without their consent, and 14.1% reported having had injuries as a result of being hit, slapped, punched, shoved, kicked, or otherwise physically hurt by an intimate partner.[ii] Pregnancy-related problems are significantly higher for abused women, such as prenatal fetal injury and complications of pregnancy including low weight gain and infections.[iii] At its extreme, IPV is the leading cause of maternal death. [iv], [v] There is also well-established evidence that high incidences of IPV and child maltreatment co-occur within the same family.[vi] Oregon Child Welfare statistics for 2011 show 35.2% of child protective cases with founded child abuse had domestic violence as a “family stress indicator”.[vii]
Not only is IPV a significant social determinant of a woman’s overall health, safety and well-being, it is a substantial issue for child welfare programs and health care systems in Oregon. On-site advocacy services offer a form of intervention within these systems that supports positive outcomes for both pregnant and parenting women and for the systems in which they are involved. The focus of the Oregon Department of Justice (ODOJ) project, titled “Oregon Safer Futures” is to improve pregnant and newly parenting women’s safety and well-being by increasing access to IPV advocacy services within child welfare and health care systems.
Oregon Safer Futures funds seven non-profit victim advocacy organizations to place advocates on-site at Child Welfare branch offices, local Public Health departments and in other healthcare settings. Each Oregon Safer Futures project site engages in three main strategies including 1) advocacy intervention, accompaniment and supportive services provided by the on-site advocate, 2) case consultation and provider training and technical assistance, and 3) capacity building efforts designed to sustain the project beyond the grant funding. In addition, ODOJ and its partners provide training and technical assistance for Child Welfare staff and healthcare professionals to increase their knowledge of IPV and to improve their assessment, identification and response to IPV. Oregon Safer Futures’ state and national partners include Futures Without Violence, Oregon Coalition Against Domestic and Sexual Violence, Oregon Health Authority, Oregon Department of Human Services, Portland State University - Child Welfare Partnership, David Mandel & Associates, LLC, and Portland State University – Regional Research Institute.
Research suggests that on-site advocacy interventions have important implications for reducing violence and improving a woman’s well-being over time.[viii] Advocates are uniquely qualified to help women who are victims of IPV with crisis counseling, safety planning, emotional support, help navigating complex systems, assistance in finding safe housing and parenting support. Immediate access to these services is pivotal for victim advocacy to be effective. This is important given that a pregnant or newly parenting woman who is a victim of IPV often has a narrow window of opportunity to receive assistance because of her batterer’s controlling behavior. Having on-site advocacy services also communicates to a woman that she has the power to make her own decisions about the safety and wellness of herself and her children. Additionally, on-site advocates consult with Child Welfare staff and healthcare providers to determine a course of action that promotes good health and increases the woman’s safety.
ODOJ conducted an evaluation of its previous Pregnancy Assistance Fund grant project, which contributes to the evidence-base for the current Oregon Safer Futures project. The evaluation yielded positive outcomes connected with the on-site advocacy services, including an increase in the number of women reached who would otherwise not have received services. Additionally, a majority of Child Welfare and Public Health staff reported changes in their case practice related to IPV as a result of the project, including increased assessment and screening for IPV and referrals of women who are victims of IPV to advocacy services. Most significantly, of the participating women who responded to ODOJ’s survey, 96% reported they had more ways to keep themselves and their children safe. Comments from survey respondents tell the story even better. One wrote “I was so happy (to meet the advocate) because then I realized I wasn’t alone; in a maze of bureaucracy, I had found a person who understood me, whose position was made just to help me.”
Christine Heyen, M.A.
Oregon Safer Futures
Phone: (503) 378-5303
[i] Oregon Department of Human Services. (2011). Know the Facts About Domestic and Sexual Violence. Salem, OR. Retrieved from: http://www.oregon.gov/dhs/abuse/domestic/dvcouncil/factsheet-2011.pdf.
[ii] Oregon Health Authority. (2011). Oregon Title V Maternal and Child Health: Five Year Needs Assessment. Portland, OR. Retrieved from: http://public.health.oregon.gov/HealthyPeopleFamilies/Babies/Documents/title-v/MCHB-Report.pdf
[iii] Parker, B., McFarlane, J., and Soeken, K. (1994). Abuse during pregnancy: Effects on maternal complications and birth weight in adult and teen age women. Obstetrics & Gynecology, 3, 323-328.
[iv] Horon, I., & Cheng, D. (2001). Enhanced surveillance for pregnancy-associated mortality – Maryland, 1993-1998. Journal American Medical Association, 285, 1455-1459.
[v] Nannini, A., Weiss, J., Goldstein, R., Fogerty, S. (2002). Pregnancy-associated mortality at the end of the twentieth century: Massachusetts, 1990-1999. Journal of the American Women’s Association, 57, 140-143.
[vi] Family Violence Prevention Fund. The Facts on Children and Domestic Violence, Family Violence Prevention Fund. San Francisco, CA. Retrieved from: http://www.lessonsfromliterature.org/docs/Children-and-Domestic-Violence.pdf
[vii] Oregon Department of Human Services. (2011). Oregon Child Welfare Data Book. Salem, OR. Retrieved from: http://www.oregon.gov/dhs/abuse/publications/children/2011-cw-data-book.pdf.
[viii] Coker, A.L., Smith, P.H., Whitaker, D.J., et al. (2012). Effect of an In-Clinic IPV Advocate Intervention to Increase Help Seeking, Reduce Violence, and Improve Well-Being. Violence Against Women, 18:118. doi: 10.1177/1077801212437908
Spotlight on: State of Vermont
The Learning Together Program Helps Teen Parents and Their Children Succeed
Summary: The relationship between academic failure and teen pregnancy is strong: parenthood is a leading cause of school dropout among teen girls, and fewer than two out of five (38%) of moms who have a child before they turn 18 have a high school diploma. Even more disturbing is the rate of repeat pregnancies among women aged 15 – 19. According to the Vermont Department of Health, for the years 2006 – 2008, there were 1,596 first pregnancies among women age 15 to 19 in the state. Of those women, 583, or 36%, had a second or higher pregnancy while in that age cohort.
The Vermont Department for Children and Families Child Development Division is providing support for pregnant and parenting teens through the Learning Together Program (LTP). For fiscal year 2012, 294 young parents participated in the 16 LTP sites statewide. Most of the participants in the LTP enter with multiple challenges such as unstable homes, poverty, violence, neglect, and physical and sexual abuse. Many participants lack confidence in both themselves and in those institutions designed to support them. They struggle to become self-supporting, contributing workers, citizens, and parents because they lack the most basic information and skills needed to meet multiple demands. The goal of LTP is to give program participants the knowledge and skills they need to be successful parents, citizens, students, and employees.
Available at high schools and community services centers, LTP focuses on building pregnant and parenting teens:
- Communication skills,
- Job readiness skills, including high school completion, and
- Parenting skills.
The department works with partnering community-based organizations to reach pregnant and parenting teens and women by providing intensive pre-vocational, interpersonal, and parent training. LTP strives to ensure that all enrolled parents will demonstrate an enhanced ability to care for themselves and their children.
Using the Pregnancy Assistance Fund grant from the Office of Adolescent Health, the state hired an independent evaluator to conduct a comprehensive evaluation of the program. The evaluation plan includes several components:
- an evaluation of the parent child centers (PCC) to determine the stage of LTP program development,
- an evaluation of LTP program participants to determine if the desired outcomes were being achieved, and
- a community assessment to identify ways to reach out to teens not participating in the LTP.
Additionally, LTP participants were also asked to complete a written participant satisfaction survey. A total of 136 survey responses were received and the results were analyzed. Overall, respondents were highly satisfied with the LTP programs, feeling that the programs were respectful, responsive, and made a difference in their lives.
Karen Garbarino, MPA
Children’s Integrated Services Director
Vermont Department for Children and Families
Spotlight on: State of Tennessee Department of Health
Developing and Utilizing a Teen Advisory Committee
Summary: Shelby County Tennessee faces a higher rate of births to teenage mothers than the national average (15% compared to 11%). These teen mothers and their partners face a myriad of other obstacles: high rates of infant mortality and low birth weights, poor maternal health, high rates of abuse and neglect, and poor early childhood development. Reducing the high rate of teen pregnancy and births and improving outcomes for teen parents and their children demands a coordinated, comprehensive approach to providing high-quality, evidence-based services to pregnant and parenting teens and women in Shelby County. The Tennessee Pregnancy and Parenting Success Initiative (TPPS) provides health, education, and social services for pregnant and parenting teens in the Shelby County area through the following ways:
- Establishing group prenatal programs at area high-schools;
- Providing vouchers for resources that pregnant and post-natal teen mothers need;
- Placing outreach workers in high-need neighborhoods to promote the availability of services; and
- Encouraging pregnant and parenting teens to stay in school and participate in early intervention and prevention programs.
To help create effective communications and outreach materials for pregnant and parenting teens, the TPPS Initiative formed a Teen Advisory Committee with two stated goals: (1) to understand the best ways to access and communicate with pregnant and parenting teens and (2) to help create effective and powerful messaging for pregnant and parenting teens using teen-friendly language. When forming the committee, the TPPS partners recruited students ages 15 to 25 with outgoing personalities, who were willing to become involved with community projects and share their thoughts and ideas with adults. The project aimed to recruit a diverse group of teens, including pregnant and parenting teens.
After a series of focus groups were completed, the committee was formed with five “core group” members, consisting of four female members (one parenting and pregnant with second child, one parenting, and two not pregnant or parenting) and one male (not parenting). Over the past year the
Teen Advisory Committee has accomplished the following:
- Assisted in selecting the official name for the pregnant and parenting teen initiative, Teen Plus (Teen+), and developing a logo and other useful branding suggestions for promotional items.
- Supported program recruitment efforts. With the active involvement and suggestions from the Teen Advisory Committee, and along with other promotional activities, over 75 participants (approximately 23.4% of the stated goal) were recruited within two months from the official start of the program.
- Participated in a YouTube recruitment and educational video for the Teen+ initiatives. http://www.youtube.com/watch?v=38SwkXShS4s&feature=relmfu and http://www.youtube.com/watch?v=oCHv4chZ4AI
- Responsible for updating content for the Teen+ Facebook page and web site to increase awareness and recruit participants.
- Provided input and suggestions on how to recruit and involve more male teens.
- Participated in two health fairs to distribute recruitment literature.
- Served as “unofficial” ambassadors at respective schools by introducing teens to the Teen+ program by word of mouth and the distribution of promotional items at schools and among friends. Committee members suggested that one of the best techniques for recruiting those who are early in their pregnancy is by “word of mouth” from trusted friends, like themselves.
- Hosted a community awareness event, “Flippin the Script,” featuring local author and teen mom Summer Owens. Three-hundred teens attended the event. The value of the Teen Advisory Committee has positively impacted the Teen+ initiative.
The TPPS partners anticipate that the continued involvement and recommendations of the teen advisory committee will help raise awareness about the initiative to teens most in need of services.
Kimothy Warren, Program Director
Adolescent Pregnancy Prevention Programs
TN State Department of Health
425 5th Ave N.
Nashville, TN 37243
Phone - 615-253-2657
Spotlight on: Government of the District of Columbia
School-based Coordinator Provides Critical Support and Encouragement to Expectant and Parenting Students
Summary: The New Heights program is a school-based model serving expectant and parenting high school students. The goals of the program are to improve attendance, increase graduation rates, and decrease the number of repeat pregnancies. Since full program implementation, the program has served nearly 600 expectant (14% of those students are student fathers) and parenting students in 13 District of Columbia Public Schools and two charter schools.
New Heights uses a youth development framework and places a dedicated coordinator in participating schools. Coordinators serve as supportive case managers; advocate for students; provide resources for other school staff members about how to best serve expectant and parenting students; and act as role models and mentors. There is also a Special Populations Coordinator who serves students in the foster care system.
Specifically, New Heights offers the following to expectant and parenting students:
- Supportive case management and assistance with accessing community resources such as a childcare voucher, the Women, Infants, and Children program (WIC), housing, Temporary Assistance for Needy Families (TANF), employment, job training opportunities, college/university admissions and more.
- Educational workshops through a network of community partnerships including such topics as pre-natal care, parenting, life skills, financial literacy, career planning, healthy relationships and other issues concerning today’s youth.
- Incentive program that allows participants to earn free items for their children such as diapers, clothing, toys, equipment, and accessories.
- Transportation assistance for eligible program participants for transportation tokens to/from school and/or a daily stipend (if eligible for Temporary Assistance for Needy Families).
Young Mother and Student Beats the Odds
An eighteen year old mother of twins, sought assistance from the New Heights program. Feeling isolated and unsupported since her pregnancy, this young mother believed completing high school and attending college was impossible. Through New Heights the student received assistance with the college application process, supportive case management, mentoring, workshops (parenting, reproductive, nutrition, child development etc.), and linkages to various government and local non-profit resources. While enrolled in the program, the student maintained a 3.0 grade point average, and learned to balance school assignments and being a good mother for her twin girls. She was accepted to four colleges and universities and received financial assistance.
In the summer of 2012, the program conducted two focus groups among New Heights participants, one male and one female. Participating students were asked eight questions to measure their overall satisfaction with the program, optimum ways of promoting the program, most effective services, components that should be added, and impact of the program on participants’ lives. Student participants indicated that the "focal point" for their success with the program was their school’s coordinator. Students also indicated that the program helped them to increase their self-confidence, motivation, and self-esteem. Additionally, the New Heights program helped students to address their stresses and fears associated with being expectant and/or parenting.
Spotlight on: Virginia Department of Health
Institutions of Higher Education Providing Critical Resources to Pregnant and Parenting Student-Parents
Summary: Virginia’s Office of Adolescent Health-funded Pregnancy Assistance Fund (PAF) initiative provides support to young adult (ages 18-29) male and female students enrolled in institutions of higher education who are pregnant or parenting young children under the age of 5 (student-parents). Primary activities of Virginia’s PAF funding include the establishment of the Offices of Pregnant and Parenting Student Support (OPPSS); the development of a peer mentor program; enhanced efforts to identify and refer services for student-parents experiencing sexual assault, intimate partner violence and stalking issues; and the development of a targeted public awareness campaign to promote on-campus support programs for student parents.
The Virginia Office of Child and Family Health Services, housed with the Virginia Department of Health (VDH), contracts with eight institutions of higher education, spanning 22 sites/campuses, to provide services to student-parents. Partnering schools include Norfolk State University, Northern Virginia Community College, Patrick Henry Community College, Paul D. Camp Community College, Southside Virginia Community College, Southwest Virginia Community College, Tidewater Community College and Virginia Western Community College.
Student-parents participating in campus-based PAF programs are connected with resources and services that facilitate their ability to complete their schooling while balancing their paramount responsibilities as a parent. Student-parents can be referred to the OPPSS by a professor/administrator or may self-enroll. They are linked with resources and provided with enrollment assistance for a myriad of health, social, and educational programs and services. Student-parents’ needs are assessed during an initial visit to an OPPSS, which is followed by an immediate referral to services and resources or a follow-up with staff as needed. Additionally, the OPPSS sites strive to meet the immediate or emergency needs of student-parents by providing access to “baby pantries” that stock typical baby care products and gas cards or transportation passes to get to and from school. Some sites also provide free professional and ongoing counseling services and emergency stipends that may assist in covering housing, food or childcare assistance.
To recruit, engage, and retain student-parents Virginia employs a variety of methods, including:
- Hosting program kick-off events to announce the establishment of a new student-parent support program and to recruit interested students;
- Participating in informal meetings and group activities designed to support the emotional needs of student-parents;
- Using peer mentors to assist in program marketing and participant recruitment; and
- Coordinating efforts with larger campus-based program activities.
The program reports a multitude of successes. Numerous student-parents have received assistance locating emergency housing, food, and childcare. Two sites have established lactation rooms to provide student-mothers safe and private breastfeeding locations. Each site has introduced at least one campus-based campaign per year to raise awareness of domestic violence, sexual assault, and stalking. Virginia also launched a statewide media campaign to promote each OPPSS. This included customized radio and TV ads aired in college service markets; development of posters, brochures and call cards; and the launch of an OPPSS website to provide additional information and resources.
In addition to the direct work with student-parents, the program has also built several key partnerships and community connections. Some examples include:
- Coordination with local and community-based partners to provide services conveniently on campus instead of students being referred out;
- Identification and provision of direct contacts to local family planning clinics, regional perinatal councils, and area health departments;
- Participation in free media promotions for OPPSS sites offered by local media and news outlets; and
- Solicitation of local funding through the partner colleges and universities to support program sustainability.
Efforts to monitor and track program efforts and success are also underway. The grantee developed and launched a quarterly student-parent program satisfaction survey and an online data collection platform for monitoring and tracking participant demographics and campus-based progress. Virginia is also creating an inventory of campus policies and procedures related to intimate partner violence and sexual assault incidents. Further, Virginia maintains an inventory of existing resources and services, by OPPSS service area, and has launched a mechanism for feedback on the program website.
Spotlight on: Intra-Tribal Council of Michigan
Support Network Helps Pregnant and Parenting American Indian Teens Achieve Educational Success
Summary: American Indian teen parents in Michigan need support to improve outcomes for themselves and for their children. American Indian communities face higher rates of poverty and lower rates of education and perinatal care. American Indian teen parents face additional challenges due to their young age and lack of economic stability; young parents age 20-24 who have not received a high school diploma are targeted by the project as well, as they face similar challenges and risks.
To date, the project has enrolled and served 224 parents (unduplicated) with home visiting case management services, including 138 teen parents, 44 parents age 20-24 without a high school degree, and an additional 47 pregnant women through the expansion of the existing home visiting program to two additional tribal sites. A total of 1,975 participants have been served through activities designed to address youth empowerment, self esteem, and mentoring along with activities aimed at education related to pregnancy and STI prevention.
Among the Ojibway, Odawa and Potawatomi people, Tribal communities in Michigan collectively known as the People of the Three Fires, pregnancy and children are traditionally regarded as sacred, and critical to each tribe’s future and identity. However, teens, women, infants and families often do not receive the healthcare and prevention services that they need to maintain good health and wellness. In addition, inter-generational effects of historical oppression, violence, and neglect have impacted health-related and help-seeking behaviors. American Indian teens who find themselves facing pregnancy and parenthood face additional challenges due to their young age, lack of experience and lack of preparation to support a family economically. Gaps in systems and capacity limitations, coupled with significant environmental and behavioral risk factors, have contributed to wide and persistent disparities between Native Americans and Whites in Michigan for a number of health and social indicators. For teens in the target area, 49% smoked during pregnancy and 41% live with others who smoke (2011 Vital Statistics, MI Live Birth Records, Michigan Dept. of Community Health)
Seventy-seven percent of all American Indian births to teen mothers in Michigan were covered by Medicaid (indicating a household income at or below 185% of the federal poverty level); this compares to only 45% of all births in the State being covered by Medicaid. Within six of the 20 counties included in the proposed project target area, 100% of American Indian teen births were covered by Medicaid (2011 Vital Statistics, MI Live Birth Records, Michigan Dept. of Community Health)
The Support Network for Anishinaabe Pregnant and Parenting Teens (SNAPPT) strives to address disparities in maternal, infant, and early childhood health and social indicators among the American Indian population in Michigan, with a special focus on teen parents. It does so by expanding an existing home visiting case management program, the Inter-Tribal Council’s Healthy Start Project, to six new counties, including two additional tribal communities, for a total of ten community sites. SNAPPT provides case management, home visiting, individualized education, referrals, follow-up, and community education to pregnant and postpartum mothers and their infants under age two. SNAPPT expands the service area from 14 counties to 20 counties. These newly added counties have significant unemployment rates and limited health and human services programs. From 2004-2008, in the 20 county service area, there were 395 American Indian teen births, constituting 13 percent of all American Indian births. In that same area, only 7 percent of White births were to teens. From 2009-2011, there were 292 American Indian teen births (13.6% of all births) compared to only 6% of all White births to teens.
One of SNAPPT’s main objectives is to increase the number of pregnant teens who stay in school or enroll in a high school diploma/GED completion program. Program evaluation data indicates that education retention has increased among enrolled teens from 60 percent to 80 percent after six months in the program. Ultimately, the program aims to have 90 percent of its clients meet this goal. SNAPPT offers the following supports to help pregnant and parenting teens achieve educational success:
- Upon enrollment, a Support Coordinator or Healthy Start Nurse conducts a school attendance assessment. The status of the teen’s school attendance is reviewed at each monthly follow-up visit.
- Each pregnant teen in the program develops a post-partum education completion plan. The plan includes identification of supports needed (such as provisions for child care) and identifies diploma completion programs and other local opportunities for education and personal growth
- Support Coordinators provide referrals to local alternative education programs when appropriate.
- The program uses Community Resource Manuals, which were expanded to include academic and educational support programs.
Elizabeth Kushman, Healthy Start/SNAPPT Program Director
Lisa Abramson, Evaluator
Inter-Tribal Council of Michigan
Phone: (906) 440-5660