Progress on the San Diego Adolescent Pregnancy and Parenting Program Adolescent Family Life Care Demonstration Project

Amy Pan, Ph.D., Research Associate, Institute for Public Health, California
Laurie Campbell, LCSW, MPH, San Diego Adolescent Pregnancy and Parenting Program, San Diego Unified School District, California

Introduction

The San Diego Adolescent Pregnancy and Parenting Program (SANDAPP) AFL Care demonstration project is an intensive case-management model involving weekly contact with the teen, father of the baby, teen’s parents and siblings as appropriate. The model includes crisis intervention and counseling around the changes the family faces when their teen is expecting a baby. Plans and goals will be established with each family member and father of the baby where applicable. The evaluation compares an intensive case management program to a monthly case management program to address the following:

Are there lower rates of repeat pregnancies in the CARE Project than in the AFLP Program?
Do clients in the CARE Project show higher educational attainment than clients in the AFLP Program?
Do clients in the CARE Project report greater perceived family support than clients in the AFLP Program?
What are the determinants of successful intervention outcomes?
Are changes resulting from the interventions maintained over time?

Specific outcome objectives include tracking repeat pregnancies, prenatal care usage, infant/child immunizations, and attainment of educational goals; and assessing knowledge change in clients participating in parenting education.

Methods

SANDAPP will use a randomized prospective study design to test the efficacy of intensive in-home mental health case management services and parenting classes as compared to monthly in-home case management services (Adolescent Family Life Program -AFLP). The AFL program utilizes Master level and above Therapists, who meet weekly with their clients, compared to the AFLP program which utilizes bachelor level case managers who meet with their clients monthly to link and refer to services, focusing on health of mother, health of child and education. All adolescents who are referred to SANDAPP and meet the criteria (zip codes, time to graduation) will be told about both programs and will be asked whether they are willing to be randomly assigned by SANDAPP to either the Care Project or AFLP. Those who do not wish to be randomly assigned to a program may be placed in AFLP.

Measures

All participants in the Care Project and AFLP will be given the following standardized measures as part of the program evaluation: AFL Core Data Collection Instrument to track repeat pregnancies, prenatal care, and infant and child immunizations; and the Family Environment Scale to measure perceived family support.

Data Collection

Data will be collected from clients during the assessment phase of each program, for pregnant teens within one month of the birth of the child and for all participants at six month intervals, post-partum, both during intervention and up to two follow ups post-intervention.

Data Analysis

Chi-square test of homogeneity and independent sample t-tests will be conducted to assess differences between groups at posttest. We will also conduct paired t-tests to measure differences between pretest and posttest levels within each intervention to test its effectiveness.

Logistic regression will be utilized to find factors that describe the relationships between program success (the outcome/dependent variable) and demographic, baseline information, client participation and service utilization (independent variables). It is expected that some variables may be correlated. These variables will be assessed on an individual basis prior to inclusion into a model. All protocol was submitted to an IRB process and approved.

Results

We just started providing services to clients in July 2008 and do not have any results yet. We currently have 24 clients enrolled in the Intensive Case Management services, ranging in ages from 11 to 18 years old, with the majority having the client and/or family speaking Spanish. The preliminary services show many families are struggling with the changes to their family system and are interested in services that will help them achieve the objectives we are focused on, including health concerns, parenting, family stress, and education.

Discussion

We anticipate that intensive mental health case management services will assist in facilitation of the teen’s and families goals including, enrollment in school and/or job training, obtaining medical services for themselves and the baby, reduction of psychosocial stressors and development of healthy living practices, parenting skills, education on child development and nutrition, and pregnancy prevention, as well as follow-up on referrals given for family planning and education on sexually transmitted diseases. The implementation phase included learning how to present both programs to clients and their families in a way that gave them an accurate understanding without overwhelming them. Initial contact was by phone, which had limited results. When we began explaining their options in person at a home visit the results improved greatly, although this delayed the process of intake for those who ended up not being interested in AFL services. In addition our randomization table was not working correctly so all clients have been assigned to the Intensive services. This has now been fixed and we expect the programs to equalize.

Implications

Pregnant and parenting adolescents by their very nature typically come into a program such as CARE or AFLP with multiple problems and concerns. The SANDAPP AFL CARE demonstration Project hopes to show how intensive services aimed at involving the entire family in planning for the changes to the family system as well as to the teen, can improve the stability of the family and increase support for the teen parent in assuming responsibility for the health and well being of their child. It appears many families are interested in intensive services, although due to their busy schedules attending weekly appointments may be difficult.

Contact Information

Contact person during abstract review: Laurie Campbell
Telephone: 619-235-5018
E-Mail Address: lcampbell@sandi.net