How Can We Help Teen Parents Succeed? Use of a School-Based Case Management Approach

Barbara Kyle, BSN, MPH, PHN, Minneapolis Public Schools, Minnesota
Andrea Aga, BS, Becky Koltes, BS, Mary Pat Sigurdson, BA, MA, Broadway High School, Minnesota
Heather Palenschat, BA, Michelle Weltzien, BS, Nancy Lee Leland, MSW, MPH, PhD, University of Minnesota

Introduction

Devoted exclusively to young mothers and their children, Broadway High School on the north side of Minneapolis, Minnesota uses an intensive, one-on-one case management model to provide services to every student for as long as she remains enrolled. Ranging in ages from 14 to 21, the mostly African American students face many difficult challenges such as homelessness, poverty, and significant gaps in their education, in addition to those of young parenthood. Our evaluation tests the effectiveness of this model in assisting these students to stay in school, in making progress toward graduation, in delaying a second birth, and in keeping their young children fully immunized.

Methods

The impact of this model will be tested using a quasi-experimental research design that measures the key outcomes stated above, over time, among 3 cohorts of program participants (students attending Broadway High School) and non-participants (pregnant or parenting teens that do not attend Broadway, but do live in Hennepin County, the county in which the school is located). Non-participants comprise the comparison group and include young women that meet study eligibility requirements. To be eligible for the study young women need to be 18 years or less, pregnant or parenting, and eligible for public assistance in Hennepin County. The first cohort included young women that attended Broadway High School in the 2007-2008 school year (intervention group) and young women that did not attend the school but lived in Hennepin County (comparison group). The second and third cohorts will include new or newly eligible Broadway students that attend this school in the 2008-2009 and 2009-2010 school years and teens identified living in the County.

Examining key outcomes among students attending more than half the school year compared to those attending less than half will further test the impact of the model. Amount of school attendance is conceived as a measure of intervention dosage and we hypothesize that students attending more than half the year compared to less will have better outcomes. Measures of the model include amount of program exposure (dosage), level of student need, and intensity of case management services received (amount and type of services). Each year, the project aims to recruit 3 cohorts of 50-100 participants and 50 non-participants for a total of 400 by the end of the study. Data will be collected at baseline and 12-month intervals for each of the 3 cohorts. Data collection methods include use of the Adolescent Family Life’s (AFL) baseline and 12-month follow-up CORE written self-administered survey for pregnant and for parenting teens; additional survey questions developed by our evaluation team and case managers; use of secondary data from school district, county, and state records; and use of case manager records. These data collection instruments and secondary sources will provide information about the rate of repeat births, progress toward graduation, graduation rates, and childhood immunization rates as well as process information about program dosage such as school attendance. Data analysis for year one included descriptive statistics, chi-square, and t-tests. Data analysis for year two (not yet complete) will include descriptive as well as inferential statistics such as chi-square, paired t-tests, and ANOVA. The project received initial approval from the University of Minnesota Institutional Review Board (IRB) on April 18, 2007 and continuing approval up until March 19, 2009 on March 19, 2008. Reapplication will be submitted by January 19, 2009 for continued approval.

Results

Results available for presentation at this time are from year one, the year data collection started, and are focused on examining outcomes among students that attended school more than half the school year compared to those that attended less than that. Further, data are from a secondary source—school records. At a later date, year two results will report findings from the first of our 3 cohorts where we will have implemented our quasi-experimental design and gathered data from the AFL CORE surveys.

Analysis of year one data showed that compared to students attending school less than half the year (n=189), a greater proportion of those attending school more than half the school year (n=167):

Participated in Not Ready Now, a repeat pregnancy prevention program (45% vs. 13%)
Received case management services (99% vs 87%)
Had their child enrolled in onsite child care (55% vs 17%)
Returned to Broadway in fall of 2007 (66% vs 32%)
Stayed in school (67% vs. 36%, p<. 01),
Earned higher test scores (68% vs. 46% p<. 01, passed the Minnesota Basic Standards Test, MBST, in reading and 35% vs. 29%, p<. 01 passed the MBST in math)
Were on track to graduate in 4-5 years (25% vs. 10%, p<. 01)
Avoided chronic absenteeism (24% vs. 62%, p<. 01)
Ready to graduate high school (twice as many teens, 16% vs. 7%, p<. 05 were both credit and MBST ready to graduate).

The number of subsequent pregnancies among students who were 19 or less and eligible for public assistance equaled 24 or 8%. The number of births that resulted from these pregnancies is not known at this time, but will be reported at a later date. A rough comparison (i.e., rough because it compares repeat pregnancies to repeat births) for this is the city of Minneapolis where, in 2005, 22% or 127 teen moms had a repeat birth. Minneapolis is the city in which Broadway School is located.

The number of children of students among the entire student body of 385 at Broadway for the 2006-07 school year was about 282. These 282 children were enrolled in the childcare at Broadway at some point during the school year. Of these, approximately 98% were fully immunized. This number is understandably high since Broadway School has childcare on-site and requires that children are up-to-date on their immunizations before they can be admitted. Immunization status of children not enrolled in day care at Broadway School is not known. Attempts to collect these data will be made through county data sources. A rough comparison of immunization rates for children of teen mothers can be made using data from the city of Minneapolis and from Hennepin County. These data show rates of immunization for children at 2 years of age at 47% in Minneapolis and 62 % in Hennepin County.

Discussion

Our findings indicate that students that attend Broadway High School for half the year or more tend to perform better and in some cases much better than those attending less. Students attending more than half the year had fewer repeat pregnancies, were on track to complete school, and had their child enrolled in the school’s on-site child care (which meant they were fully immunized since this is a requirement for enrollment) compared to those attending less than half the school year. Based on these preliminary findings, we are encouraged that the school-based model used at Broadway, which includes, as a key component, case managers that work with each student as long as she is enrolled, may hold promise in having a positive impact on the lives of these young mothers. We anticipate that we will see similar findings in year two among students by amount of school attendance and between intervention and comparison group adolescents.

A key challenge involves difficulties with locating some of the young women in both intervention and comparison groups so that they can complete the AFL CORE 12-month follow-up survey. These women are highly mobile and difficult to locate once they leave the school or county social services. We have collected information from study participants at baseline that will hopefully increase the likelihood of locating them if they leave the school or county. A major programmatic challenge involves keeping these young women in school. Because they face many extreme challenges in addition to young parenthood, such as homelessness, poverty, and significant gaps in their education, strategies employed to keep them enrolled take much of the energy and skill of our case managers and other school staff.

Implications

Young mothers facing difficult challenges in addition to young parenthood can make progress toward graduating from high school and do succeed at building strong and productive lives for themselves and their children. Our job is to learn what strategies inspire their lives and support their efforts and practice them. Strategies such as a school-based intensive case management approach need to be carefully studied and improved. As we conduct this evaluation and devise systems to track information about outcomes and process, staff at Broadway School are continuously clarifying their understanding of case management and how to measure its impact. Some of the outcomes of this process will be a comprehensive written literature review on school-based case management, new job descriptions for case managers, better written descriptions of what case management involves, and better strategies for measuring its impact.

Contact Information

Nancy Leland
612-624-8134
nancylee@umn.edu