A Review Of Teen-Tot Programs: Comprehensive Clinical Care For Young Parents And Their Children

Adolescence, Summer, 2001 by Lara J. Akinbami, Tina L. Cheng, Dana Kornfeld

ABSTRACT

Comprehensive clinical programs for teenage mothers and their children, also known as teen-tot programs, have been a promising intervention to improve outcomes of teenage childbearing and parenting. However, much remains unknown regarding the efficacy of such programs. We reviewed four published evaluations of programs that provided medical care, counseling, contraception, guidance for parenting, and assistance with staying in school. The evaluations reported moderate success in preventing repeat pregnancies, helping teen mothers continue their education, and improving teen and infant health over 6 to 18 months. However, the evaluations had limitations that may have reduced or accentuated observed effectiveness. Teen-tot programs will continue to face the challenges of sustaining adequate long-term interventions and evaluations, and reducing the high attrition rate among program participants. It is concluded that increased support and funding for teen-tot programs and more complete evaluations are warranted.

Teenage childbearing poses risks for teenage mothers, such as higher risk of inadequate education and living in poverty, and their infants, including poor birth outcomes and long-term learning and behavior problems (Card & Wise, 1978; Furstenberg, Brooks-Gunn, & Morgan, 1987; Baldwin & Cain, 1990; Fraser, Brockert, & Ward, 1995; Jekel, Harrison, Bancroft, Tyler, & Kierman, 1975). Furthermore, repeat pregnancy rates among teenage mothers of low socioeconomic status may be as high as 39% within one year of delivery (Linares, Leadbeater, Jaffe, Kato, & Diaz, 1992) and 50% within two years of delivery (Polit & Kahn, 1986). Each additional childbirth increases the chance that a teenage parent and her children will live in poverty for a longer period of time by postponing the teenager's return to school or reducing her ability to find employment (Furstenberg et al., 1987). Despite the declining rate of repeat births to teenagers, in 1998, nearly 110,000 births (22% of all births to teenagers) occurred among teenage rs who were already mothers (Ventura, Martin, Curtin, Mathews & Park, 2000).

Teen-tot programs were established to prevent poor outcomes for teenage parents and their children. These comprehensive clinic-based programs serve teenage mothers and their infants in a single setting and typically offer health care, family planning, counseling, encouragement for teenage mothers to continue their education, assistance with obtaining services, and social support. By providing "one-stop shopping" for this high-risk population, the teen-tot model is designed to remove barriers to receiving care that exist in traditional care models, such as transportation difficulties, lack of continuity of care, and lack of case management. A central goal is to prevent rapid repeat pregnancy by simplifying access to contraception, discouraging school dropout, and encouraging the pursuit of careers that provide economic security. In addition, components of these programs are designed to improve infant and teen health and parenting practices.

Concern has been raised about the inadequate evaluation of programs for teenage mothers (Stahler & DuCette, 1991; Stahler, DuCette, & McBride, 1989). Previously published reviews of teenage parent program evaluations have not specifically focused on postnatal clinic-based interventions targeted at both mother and child (Scholl, Hediger, & Belsky, 1989; O'Sullivan, 1991). We sought to review the experience of teen-tot programs in meeting the goals of improving outcomes and preventing repeat pregnancies.

METHOD

Published medical literature was systematically searched via computerized databases. Medline, Popline, and Health Star were searched from January 1980 to August 2000 using the terms "pregnancy in adolescence," "parents," and "program evaluation." The Psych Info database was searched using the terms "adolescent mothers," "adolescent pregnancy," and "program evaluation." Two investigators independently reviewed the results of each search to identify articles that were potentially eligible for inclusion. In addition, bibliographies of articles identified through the search were examined for additional eligible articles. Initial criteria included a title and abstract, if available, that described a comprehensive program for pregnant and/or parenting teenagers and their children.

Potentially eligible articles were reviewed in entirety by three investigators to determine which described a comprehensive clinical teen-tot program, that is, a program including clinical health supervision, family planning, and support for teen parents, such as assistance with staying in school or obtaining community services. Each article describing a comprehensive teen-tot program was rated in four areas: (1) statement of goals used to develop the program, (2) statement of the intervention content (i.e., the parameters, intensity, and target of the intervention, as well as the staff involved in conducting the intervention), (3) description of study design: size and characteristics of the target group and the comparison group (randomized, matched, or convenience), program duration, and data collection procedures and intervals, and (4) program impact evaluation: use of reliable outcome measures and appropriate impact analyses, including statistical significance (Bauman, Drotar, Leventhal, Perrin, & Pless, 1 997; personal communication, L. J. Bauman).