A randomized trial of a health care program for first-time adolescent mothers and their infants
The goals of this untitled program for disadvantaged adolescent mothers are to prevent second pregnancies, maintain attendance at a clinic so that infants have up to date immunizations, have adolescent mothers resume schooling, and reduce the use of emergency room for routine infant care. The program randomly assigned adolescent mothers 17 years of age or younger to an intervention or control group. The program provides routine care for mothers as well as additional special care. Mothers in the experimental group were less likely to have a repeat pregnancy, and their infants were more likely to be fully immunized. There was no impact on return to school. Clinic drop out was high, but was lower for those in the treatment than in the control group. Use of emergency rooms was somewhat lower; but the difference was not significant.
DESCRIPTION OF PROGRAM
Target population: the program targets first-time adolescent mothers who had recently given birth.
This special health care program has four goals. The program tried to prevent second pregnancies, maintain attendance at clinics so infants could receive up to date immunizations, have adolescent mothers return to school, and reduce emergency room use for routine infant care. The program provides regular routine care as well as additional special care.
The routine care consists of appointments for appropriate immunizations and referrals to social services. Special care consists of on site social services. These services include counseling, referrals to a birth control clinic, and parenting instruction by a social worker. In addition, mothers were asked their plans for returning to school and were given instructions on how to manage parenting issues. Finally, participants receiving special care were given follow up calls and letters if they missed their appointments.
EVALUATION(S) OF PROGRAM
Evaluated population: 243 first-time adolescent mothers and their infants were randomly assigned to either a program or control group.
Approach: All mothers in the sample were African American, unwed, and Medicaid recipients who had delivered a healthy baby at a large urban hospital in the eastern US. In total, 120 mothers were assigned to the experimental group and 123 mothers were assigned to the control group. Control participants were provided with routine care and experimental participants were provided with routine care and additional services by a social worker, pediatrician, and a nurse practitioner. There were no statistically significant differences between the groups at baseline.
Data were collected through interviews with mothers, school records, and hospital records during the mother's postpartum stay at the hospital. Data were also collected on demographics, emergency room and clinic use, repeat pregnancy, immunizations, return to school, and physician care.
Results: Results of the study indicated that participants in the program attended significantly more well-baby visits. While both groups had high dropout rates, members of the experimental group were less likely to drop out of the clinic. Further, experimental participants had significantly fewer second pregnancies than control participants. However, based on non-experimental analyses when breaking up the groups, drop-outs carried the weight of this difference. In other words, among drop-outs, those in the program group were less likely than those in the control group to have a second pregnancy. It appears that even minimal exposure to the program decreases the likelihood of repeat pregnancies. With regard to immunization, significantly more infants in the program group were fully immunized than those in the control group. The researchers did not find a significant difference for mothers returning to school and found a non-significant difference for the use of emergency room care for infant care.