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Improving Teen Pregnancy Outcomes

UCLA SoN program reaches out to adolescent Latina and African-American mothers.

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In 2010, U.S. women ages 15-19 years gave birth to 367,752 infants.1 Though the country's birth rates fell 12 percent for women ages 15-17 years and 9 percent for women ages 18-19 years, it still has the highest teen pregnancy rate than any developed country.2

Considerable social and economic costs are associated with early child bearing, including increased incarceration rates, healthcare and foster care, and lost tax revenue, reports the CDC.

"Teen mothers and their children often lack necessary resources and, consequently, face increased risk for themselves and their children," explained Deborah Koniak-Griffin, EdD, RNC, FAAN, professor, UCLA School of Nursing.

In fact, the CDC reports only about 50 percent of adolescent mothers obtain a high school diploma by age 22. That statistic jumps to 90 percent when referring to female teens who didn't give birth. Additionally, studies have shown children of teenage mothers don't perform as well in school, are more likely to drop out of high school, have extra health problems and are more likely to be incarcerated in their teenage years.1

To help improve pregnancy outcomes among young Latina and African-American adolescents, the UCLA School of Nursing developed the Public Health Nursing Early Intervention Program (PHN-EIP) for Adolescent Mothers. The collaborative demonstration project was recently chosen by the U.S. Department of Health and Human Services as a model program eligible for funding under the Affordable Care Act.

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Building the Foundation

PHN-EIP is an evidence-based home visitation model that provided care to pregnant and parenting young mothers by speciallytrained public health nurses (PHN).

The program is designed for first-time mothers between the ages of 14 and 19 years, and includes prenatal group education and home visits from pregnancy through the first year post-birth.

During home visits, PHN uses a variety of teaching and coaching methods to cover five main content areas: maternal and child health, sexuality and family planning, maternal role, life skills and social support systems.

The program was designed by Koniak-Griffin and her colleagues, including Inese Verzemnieks, PhD, RN, and Janna Lesser, PhD, RN, CS, who were both doctoral students at the time.

When the UCLA School of Nursing developed the intervention program, the rate of teen pregnancy and births was very high and disproportionately affecting adolescents of ethnic/racial minority groups who often had less socioeconomic resources.

"Our team had been working in the field of maternal-child health in both clinical and educational settings. Our experiences with pregnant and parenting teens and their children provided the foundation for our interest in investigating approaches to improving their health outcomes and life course," said Koniak-Griffin, who is also the director of the Center for Vulnerable Populations Research.

The team had the opportunity to collaborate with the San Bernardino County Department of Public Health, Division of Community Health Services, and was successful in securing funds to support program implementation and evaluation.

Positive Effects of Home-Visiting Programs

In the original research study, services were delivered from pregnancy (26 weeks gestation or less) through the first year post-birth. The outcomes of the programs for mothers and children were evaluated through 2 years post-birth.

The program offered approximately 17 home visits to high-risk pregnant young women from the middle of pregnancy through the end of the child's first year.
 
During pregnancy, visits revolved around childbirth preparation, self-care and motherhood preparation.

After the child was born, new moms received family planning education, infant care, well-baby healthcare information and life skill building activities. Prenatal group education consisted of four classes.

Evidence-based home-visiting programs can have both short- and long-term effects on the well-being of children and families, reports the Department of Health and Human Services.

Positive outcomes can include improved child and maternal health, child development, school readiness, parenting practices, family economic self-sufficiency and reductions in child maltreatment.

Those findings are backed by UCLA's demonstration project results. Two years following their involvement in the program, participating babies had considerably fewer hospitalization days than the non-EIP group (143 days versus 211days).

Moreover, Early Intervention Program mothers had fewer repeat pregnancies in the first 2 years after giving birth.3

"The adolescent mothers receiving the early intervention program had low rates of preterm births and a 15 percent reduction in repeat pregnancy compared to those receiving standard care," Koniak-Griffin said. 

"Their children had improved decreased total days of infant hospitalization during the first 2 years of life and a 96 percent rate of immunization in the first year of life. They were also less likely to use the emergency room," she said.

Substance use also decreased significantly during pregnancy and never returned to the preconception levels following childbirth.

Koniak-Griffin noted tPHN-EIP does not provide direct prenatal care.

"Our focus is on teaching and coaching of young mothers to improve self-care, care of their infant, parenting skills, family planning practices and social outcomes (e.g., school completion, securing employment), as well as to decrease/eliminate high-risk behaviors and build competence in managing their lives and securing needed resources," she clarified.

The public health nurse employs a case management approach to provide care designed to promote health of the young mother and her child from pregnancy through the postpartum period (1 year).

"The nurse is a teacher, coach and facilitator of skill development," commented Koniak-Griffin.

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One of a Kind

To her knowledge (and that of her colleagues), Koniak-Griffin is unaware of any nurse-developed home visiting programs offering pregnancy through early childhood intervention, though she does mention the Denver-based Nurse-Family Partnership, developed by David Olds, PhD, a widely known and respected public health nursing model for similar services.

Pregnant teens between 14 and 19 years of age were eligible to participate in PHN-EIP if they were first-time mothers, not drug-dependent, English or Spanish speaking and without health problems that would prevent them from attending the group education. They were enrolled through the County Health Department upon referral for services.

Being selected as an "evidence-based early childhood home visiting service delivery model" signifies the rigorous evaluation criteria were met for methodology and outcome, established by the Department of Health and Human Services.

"We demonstrated impacts on primary outcomes measures in eight established areas and favorable impacts on secondary outcomes in two areas," concluded Koniak-Griffin. "We are one of the two models selected that employed nurses exclusively as home visitors."

References for this article can be accessed here.

Beth Puliti is a frequent contributor to ADVANCE.


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