Building a Road to the Future: An Evaluation of a School-Based Intervention for Pregnant and Parenting Teens
Joan Durgin, M.Ed. Polly Fox Academy. Toledo, Ohio
Joseph A. Dake, PhD, MPH University of Toledo. Toledo, Ohio
Introduction
Polly Fox Academy (PFA) is an alternative public school for 7th to 12th grade pregnant and parenting teens in Toledo, Ohio that currently has an enrollment of 268 students. This school resides in Lucas County, the sixth largest of Ohio’s 88 counties which ranks second in teen births. Additionally, nearly 25% of Lucas County teenage parents will experience a repeat pregnancy. This rate exceeds the state and national rates. To address this issue, the mission of PFA is to help pregnant and parenting teenagers graduate with the necessary academic, parenting, relationship-building, and workplace skills to be successful, self-supporting adult. To accomplish this mission, the program focuses on six objectives: 1) Reduce the incidence of repeat pregnancies among students; 2) Increased conformance with Ohio Department of Health infant immunization schedule; 3) Increase the educational attainment of the students; 4) Increase students’ parenting knowledge, attitudes, and skills; 5) Improve students’ abilities to build healthy relationships; 6) Improve students’ self-efficacy beliefs regarding academic achievement and using contraception. The intervention is an intensive team approach to help achieve these objectives. In addition to teachers focused on traditional school subject areas, PFA offers these students the availability of a full-time school nurse, a mental health counselor, an additional special education teacher, and tutoring services. There is also a parenting class teacher and an outreach prevention specialist as part of the school staff. The PFA staff work closely with community groups focused on increasing contraceptive use, increasing immunizations for the students as well as their babies, and the availability of daycare services while the students are in school. The project intensity and dosage is reinforced by the school setting. With the pregnant and parenting teens on-site daily, there is a greater opportunity for impact and intervention as needed. In this setting, PFA has the ability to provide case management as the need arises and connect both students and their families to appropriate services on a daily basis. All students who attend PFA on a regular basis (a full time equivalent student) are eligible to be included in the evaluation component. While thus number fluctuates, it is generally about 170 students. We would be seeking to get as many of these as possible to participate in the evaluation. The primary purpose of the program evaluation is to assess whether pregnant or parenting students attending a dedicated school with these services will fare better than pregnant or parenting students attending a traditional school setting.
Methods
This program is being evaluated using a quasi-experimental, longitudinal research design with a control group. Data collected for the evaluation include both service and student data. Service data include a documentation of the time, content, and interaction type for all services provided to each student in the intervention group. Student data includes survey data collected from the required AFL Core Data Instruments. These required instruments measure a wide variety of issues for pregnant and parenting students and is standardized for comparison across funded groups. Two survey components were also added to the AFL Core Data Instruments: a 35-item School Attitude Assessment Survey and a 13-item Contraceptive Self-Efficacy Survey. In addition to survey data, academic performance data that is collected through the school is also assessed. For tracking purposes, each student creates a unique 8-digit code based on a simple keypad system developed by the evaluation team. This process allows the matching of all data points while maintaining the confidentiality of the students involved. The code sheet and the surveys are administered at baseline and then every 6 months after for 3 years based on the date of birth of the student’s youngest child. In order to compare this school-based approach to a typical school environment, control students who are pregnant or parenting were recruited through counselors and school nurses at area high schools in the same geographic region as Polly Fox Academy. Analyses to assess differences between the baseline assessments include independent samples t-tests and ANOVAs for parametric dependent variables and Mann-Whitney tests and Kruskal-Wallis tests for non-parametric dependent variables. The research design methods and procedures were approved by an external human subjects review board, Independent Review Consulting (IRC) Incorporated.
Results
To date, PFA programs and services have been in place for a full academic year and baseline surveying was permitted near the end of the academic year. These activities have allowed a baseline assessment of the intervention compared to the control group and an intervention-only assessment of repeat pregnancy rates. Of the 268 students enrolled in PFA during the 2007/2008 school year, there were 3 repeat pregnancies (1.1%). This is down significantly from last year which had 15 repeat pregnancies (5.6%). This result is in comparison to Lucas County data which indicates a repeat pregnancy rate of 26%. Academically, 85 (31.5%) of these students are on the honor roll and all enrolled seniors increased their GPA since starting at Polly Fox Academy. Baseline survey data collection has begun and will continue to take place. Currently, there are 52 Polly Fox Academy students and 37 control students who have completed the baseline assessment. There were no statistically significant differences at baseline assessment between the intervention and the control group on the demographic characteristics, the behavioral characteristics, or the perception items measured on the AFL core instrument and the supplemental instruments.
Discussion
While there were no statistically significant differences between the baseline assessments for the intervention and the control groups, there were moderate non-significant differences. This is likely an artifact of the small sample size that has been collected to date. Based on the current schedule, the number in the intervention will increase to approximately 150 and the control will increase to approximately 75 students by the end of October. [These data will be analyzed and included in the poster session in December]. This should provide sufficient power to detect differences at p<0.05. By the end of the 2008/2009 academic year, all of these students will have completed the baseline and at least one follow-up assessment which will allow for the first phase of longitudinal analyses. From the collection of school data, we saw that nearly a third of the students enrolled in the school were on the honor roll. This result is considered a success since nearly 60% of teens with a school age pregnancy drop out at some point between 8th and 12th grades. Student-interaction logs were also developed and refined last academic year and have been used since the start of this academic year. At the end of this academic year, this will allow an assessment of the relationship between dosage and the stated outcomes of this project.
Implications
This program has the potential of reducing repeat pregnancy from one quarter of the pregnant and parenting teens to nearly zero while they are still in school. The increased focus on academics and job skill development has a strong potential to impact not only the students, but the communities in which they reside. With reduced repeat pregnancies, healthier children, and job attainment, the cost savings to the state could greatly exceed the costs of operating schools dedicated to helping these adolescent pregnant and parenting girls become more successful contributors to society. The current reduction in repeat pregnancy down to 1% is down from PFA’s previous year’s rate of 6% both of which are much lower than the county rate of 25%. The lessons learned so far in this program pertain largely to recruitment efforts and retention efforts. We have made changes that we feel will improve our ability to retain students in the intervention and the control groups such as end of program bonus incentives, birthday cards for student and babies, and frequent contact beyond data collection contacts. Furthermore, the efforts on the part of working with control school staff have improved as well. Periodic meetings with program staff and control school staff have resulted in excellent efforts to ensure a successful evaluation.
Contact Information
Joseph Dake
Telephone: 419-530-2767
Email Address: jdake@utnet.utoledo.edu
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