Home Visiting for Adolescent Mothers: Effects on Parenting, Maternal Life Course, and Primary Care Linkage

Abstract

PURPOSE Adolescent mothers are at risk for rapidly becoming pregnant again and for depression, school dropout, and poor parenting. We evaluated the impact of a community-based home-visiting program on these outcomes and on linking the adolescents with primary care.METHODS Pregnant adolescents aged 12 to 18 years, predominantly with low incomes and of African American race, were recruited from urban prenatal care sites and randomly assigned to home visiting or usual care. Trained home visitors, recruited from local communities, were paired with each adolescent and provided services through the child's second birthday. They delivered a parenting curriculum, encouraged contraceptive use, connected the teen with primary care, and promoted school continuation. Research assistants collected data via structured interviews at baseline and at 1 and 2 years of follow-up using validated instruments to measure parenting (Adult-Adolescent Parenting Inventory) and depression (Center for Epidemiologic Studies Depression). School status and repeat pregnancy were self-reported. We measured program impact over time with intention-to-treat analyses using generalized estimating equations (GEE). RESULTSOf 122 eligible pregnant adolescents, 84 consented, completed baseline assessments, and were randomized to a home-visited group (n = 44) or a control group (n = 40). Eighty-three percent completed year 1 or year 2 follow-up assessments, or both. With GEE, controlling for baseline differences, follow-up parenting scores for home-visited teens were 5.5 points higher than those for control teens (95% confi dence interval, 0.5-10.4 points; P = .03) and their adjusted odds of school continuation were 3.5 times greater (95% confi dence interval, 1.1-11.8; P <.05). The program did not have any impact on repeat pregnancy, depression, or linkage with primary care. CONCLUSIONS This community-based home-visiting program improved adolescent mothers' parenting attitudes and school continuation, but it did not reduce their odds of repeat pregnancy or depression or achieve coordination with primary care. Coordinated care may require explicit mechanisms to promote communication between the community program and primary care. INTRODUCTIONA dolescent mothers experience rapid repeat pregnancy in the short term, 1 depression, 2 and school dropout, 3,4 as well as a reduced probability of future economic independence. 5 Compared with their adult counterparts, teenage mothers may interact with their children less positively and have unrealistic expectations of child behavior that increase the risk of abuse and neglect. 6,7 Adolescent mothers and children growing up in disadvantaged communities affl icted by drugs, violence, and inadequate supports may be particularly vulnerable. 225 HO ME VISI T ING F OR AD OL ESCENT MOT HER SFamily physicians provide most of the adolescent medical care in the United States, 9 but the typical offi ce may fi nd it challenging to address the multifaceted needs of pregnant and parenting teenagers. Primary care clinic...

Efetividade das ações voltadas à diminuição da gravidez não-planejada na adolescência: revisão da literatura

“…24,30,32 Com relação aos estudos realizados nos grupos de adolescentes gestantes ou mães, a intervenção teve como foco exclusivo esse segmento da população e teve por objetivo evitar a reincidência de gravidez, tendo sido desenvolvida em sua maioria por profissionais de enfermagem e aplicada no domicílio ou em unidades de saúde. [25][26][27][28][29]31 Em cinco artigos, a população de estudo era de baixa renda. 25,28,[30][31][32] Com relação ao local, sete estudos foram realizados em cidades norte-americanas, 24,25,[27][28][29]31,32 um no Chile 30 e um na Inglaterra 26 (Tabela 1).…”

“…Outros estudos como os de Barnet et al 25 e Gray et al 27 destacam a importância também de se considerar a participação dos namorados ou outro membro da família na discussão do planejamento familiar para um melhor resultado do programa.…”

Community-Based Partnership to Improve Parenting Skills and Academic Achievement and Reduce Subsequent Births

“…This suggests that the core services for parenting education were sufficient to enhance parenting among adolescent females. Similarly, also using the AAPI-2, Barnet et al found that a community-based home visiting program focused on parenting had a positive impact on parenting attitudes and beliefs among adolescent mothers [1].…”

“…Adolescent mothers have been reported to experience difficulties with parenting, repeat pregnancies, and failure to complete high school [1][2]. Pregnancy in adolescence can be viewed as a complex social problem.…”

The MOM Program: Home Visiting in Partnership With Pediatric Care

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