Strengthening Family Support for Teen Parents

Mary Lou McCloud YWCA of Rochester and Monroe County
Jonathan Klein, MD, MPH
Premini Sabaratnam, MPH- Division of Adolescent Medicine, University of Rochester School of Medicine

Introduction

Young Parent Support Services (YPSS), a program of the YWCA of Rochester and Monroe County, is a community-based, non-profit agency that has worked with adolescent mothers for over three decades. The AFL Care Demonstration Project, “Strengthening Family Support for Teen Parents” serves adolescent mothers in the City of Rochester, an urban area with high concentrations of poverty in several sectors. YPSS is a school-based program, providing services to adolescent mothers in five Rochester City School District high schools and the Young Mothers alternative program. The primary target population for the AFL Demonstration Project is pregnant and parenting adolescent girls attending one of these locations. The school-based setting allows a great deal of flexibility in meeting participant needs for individual support and guidance. The in-school program offers individual counseling which occurs a minimum of every other week and includes short-term assistance, phone assistance, case management sessions, and home visits. Each school holds bi-weekly group sessions that range from 40 minutes for groups held during the school day to one hour and 15 minutes for groups held after school. The second target population is the families of pregnant and parenting adolescent mothers participating in the program; services to families are provided primarily through home visitation. Family Support Specialists (FSS) contact family participants a minimum of bi-weekly and conduct monthly home visits. The final target population is adolescent fathers; services to young fathers are provided primarily in a school-based setting

The question addressed in this program evaluation is if outcomes for participants who participate in the schools that provide family support services are better as compared to outcomes for participants who do not received the family support services. Program outcomes include: (1) 65% of YPSS participants will achieve an attendance rate of 75% or higher; (2) 85% of program participants who are seniors in September will graduate or complete GED by August; (3) 50% of participants who are in 9th, 10th, or 11th grade in September will complete two or more credits in core subjects; and (4) 85% of participants will avoid a repeat pregnancies for 24 months following entrance into the YPSS Program.

Methods

Process evaluation activities are use to identify how program services are delivered and to quantify program outputs. These data are periodically summarized and reported to be used for ongoing program quality improvement purposes and decisions related to service delivery.

Process Measures – Monthly reports from case managers are used to assess the number of pregnant and parenting teens who receive program services, the number of families who receive services, and the number of adolescent fathers who receive services. Program staff and evaluators have developed a weekly serving tracking log to be completed by case managers to track dosage, including the amount and types of services (e.g. home visits, group sessions) received by individual participants. Data from these logs are aggregated periodically for ongoing program planning and quality improvement purposes. Dosage data will also be utilized in final outcome analyses.

Outcome Evaluation Research Design

a) Design - The outcome evaluation of the YPSS program utilizes a quasi-experimental design which includes baseline and follow-up surveys with YPSS participants at 5 school-based program sites.

b) Sampling Plan and Participant Recruitment–YPSS currently provides school-based case management services for pregnant and parenting teens at 5 City of Rochester High Schools (East, Edison, Marshall, Jefferson, and Franklin) and one alternative school program for pregnant/parenting adolescents (Young Mothers Program). Under this AFL Care Demonstration Project, YPSS has enhanced their program model at East High School and Franklin High School to include support services provided to families of pregnant and parenting teens receiving case management services. The teen participants in the YPSS program at East High and Franklin High School will serve as the intervention group for the outcome evaluation, while the teen participants at the remaining sites will serve as a comparison group. Family support services will be delivered at East High for at least 2 years (project years 2 and 3) and at Franklin High School starting in the third year.

c) Comparison Group – As described above, the comparison group will be comprised of all YPSS program participants who receive program services at school based sites where family support services are not provided.

d) Data Collection Instruments –

Evaluation participants are asked to complete a baseline survey at time of enrollment, and a follow up survey once every 12 months or at time of discontinuation of program services.
Case managers maintain weekly service tracking logs to document service delivery to program participants including amount of time each participant spends in program activities and the nature of the program activities (ex. home visit, group session, individual case management).
Attendance data on evaluation participants for the school is obtained from school report cards.

e) Data Collection Process and Schedule – YPSS case managers administer written baseline and follow-up surveys. Baseline surveys were administered at the start of the study in Year 2 (for participants already on the YPSS caseload). For new participants baseline surveys are administered within a few weeks of enrolling in program services (for new program participants). Follow up surveys are administered once every 12 months from when the baseline was collected, and/or at the time of discontinuation of program services. Section I of the baseline and follow-up surveys includes items intended to measure the following short and intermediate outcomes of the YPSS program

Increase caring adult relationships
Increase knowledge of available resources
Program/staff viewed as a resource and as a connector to other resources
Increase % of teens and children who have health insurance
Increase % teens and children who have a health care provider
Increase family support

Section II of the baseline and follow up surveys are comprised of the AFL Care Program Core instruments. Data from the core instruments will be utilized to assess the three AFL care project long-term core measures:

Reduce incidence of repeat pregnancy
Increase % of up to date infant immunizations
Increase educational attainment (continued enrollment in school, completion of high school or GED)

f) Follow-up Assessment – Follow up surveys are administered once every 12 months from when the baseline was collected, and/or at the time of discontinuation of program services. On an ongoing basis, evaluation staff provide program staff with participant names and a window period in which to administer a follow up survey. YPSS received an exemption from the 2008 OAPP policy regarding a revised follow up timeline as we are currently in our fourth year. We obtained human subjects approval for the outcome evaluation in November 2006 and approval for our program in August 2008

Results

To date, 173 YPSS program participants have enrolled in the evaluation and completed a baseline assessment. Baseline and follow up data collection activities continue, with outcome analysis to occur later in the project cycle. Process evaluation results – Over the past year, YPSS worked with 313 pregnant/parenting teens. Of the 313 pregnant and parenting adolescent girls served by the YPSS AFL Demonstration Project during Year 3, 71 percent were African American and an additional 23 percent were of mixed racial heritage. One out of five participants (20 percent) identified as Hispanic/Latino. Forty (40) percent were 15-17 years of age, while 38 percent were 18 or 19 years old. Only 4 percent were under 15 years old, and 8 percent were 20 years of age or older.

Objective 1: At annual follow-up survey, 85% of participants will continue enrollment in school, graduate from high school, or complete a GED.
- Outcome: 85% of participants continued enrollment in school, graduated from high school, or completed a GED. Among seniors who participated in YPSS, 75% graduated or completed a GED. This compares very favorably to the current 58% graduation rate for all seniors in the Rochester City School District.
Objective 2: At annual follow-up survey, 85% of participants will have avoided a repeat pregnancy.
- Outcome: 89% of participants avoided a repeat pregnancy for 24 months following entry into YPSS. This is substantially higher than the national rate of 66% avoiding a second birth for 24 months. [Alan Guttmacher Institute]
Objective 3: At the end of the school year, 65% of participants enrolled in services for six months or longer will achieve a school attendance rate of 75% or higher.
- Outcome: 71% of participants enrolled in services for six months or longer achieved a school attendance rate of 75% or higher.

Discussion

Data collection activities continue. Outcome analysis and comparison of outcomes amongst the intervention and comparison group is limited by the recruitment and engagement of family members into the strengthening family support intervention. One of the most significant challenges the program has faced has been in finding strategies for engaging family members of parenting and pregnant teens to participate in the Family Support Services. FSS are having difficulties getting parents to commit to participating in the program. They want their child to participate but are so overwhelmed with other issues that they don’t have the time or energy to commit to doing anything else. . Parents are so overwhelmed with day to day issues that dealing with an older child in the home sometimes takes a back seat to finding employment or keeping food on the table. FSS often find themselves working with the parents on short term crisis intervention as opposed to long term solutions. Many families are afraid to go out at night because of the violence in some of the neighborhoods. Many of the parents of the students on caseloads are between the ages of 34 -40. Several of them were teen parents themselves. We recently held a focus group for parents to find out how we can best suit their needs. They stressed that they need help with basic needs item (food, shelter) Many parents also felt that the district wasn’t doing enough to help their children. FSS have developed several strategies to meeting with parents: invite them the coffee hour- during the day just to catch their breath and talk to another adult. Once a month family outings: this would include potluck dinners, movie nights, and bingo (with prizes). These events would include the entire family. Staff also plan on picking parents up and taking them to school open houses and parent teacher conferences and serving as ad advocate for them with the school district. Staff also plan on meeting with students and offering incentives for parents who come to events In addition, there are many times when other adults (non-relatives) are the most important individuals in the support system of the young mothers and their children. These include adult role models such as teachers, case managers, counselors, and at times, even the Family Support Specialists. However, because these individuals are not at home with the pregnant or parenting teen, their ability to impact her day-to-day interactions with her parents is limited.

Contact Information:

Mary Lou McCloud-Project Director
(585) 368-2248
mmccloud@ywcarochester.org