Thursday, October 2, 2014

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In Person or By Phone? U.Va. Study To Assess Impact of ‘Resource Mothers’ on Virginia’s Pregnant Teens

Do pregnant teens who receive weekly in-home visits from community outreach workers – so called “resource mothers” – become better parents, experience less stress, get more education and have healthier babies compared to those who receive telephone support at the same intervals? And how does race and geographical location of these home visitors have an impact?

Those are the questions being asked by University of Virginia School of Nursing professor Linda Bullock, who will oversee a newly awarded, $223,142 grant from the Virginia Department of Health to evaluate a long-running state program meant to bolster the health, educational and economic outcomes of pregnant teens, their babies and partners, using home visits.

“The home visitor may not be a ‘mother,’ but they are a critical source of support,” said Bullock, the Jeannette Lancaster Alumni Professor of Nursing and associate dean of research. “Teens may think the phone is just as good a vehicle for checking in, but on the other hand, these are pregnant girls and they may want more hands-on support than just the emotional support a phone call can give.”

The outcome of Bullock’s study – which draws participants from two areas in Virginia, one in rural Richmond County and one in bustling Fairfax County – may ultimately inform the way the state’s social services programming for pregnant teens is structured and funding is allocated.

Teens have difficulty navigating community programs and often need guidance to successfully transition from adolescence to parenthood, Bullock said, but today’s teens are also technically savvy and may respond to a more modern approach. The grant will fund the first year of the three-year project, which will cost about $650,000 in full to complete.

“Resource mothers” are community health workers who provide weekly, one-on-one education and social support to pregnant teens. They offer health education and information on parenthood, model of daily living skills and provide a conduit to community resources. A full-time resource mother serves 25 teens a year, with an average of 12 to 15 cases at a time.

The aim of the program is to assure that pregnant teenagers receive pre- and post-natal services consistent with their needs, promote healthy behaviors and practices, and increase these teens’ knowledge about child development, care and safety. The program also intends to encourage pregnant teens to continue with school and to remain employed, involve the infants’ fathers and provide a stable and nurturing home environment for positive growth and development.

The study began recruiting 250 participants from Fairfax and Richmond counties last June and split them into two groups. The first group receives weekly pre- and post-natal in-person support, while the other group receives support at the same intervals, but over the phone. Those in the phone group have their questions answered by a nurse researcher, but without any follow-up. If the research nurse doesn’t reach the teen after three attempts, activity will be suspended until the following month.

Both groups will receive support throughout their pregnancies and in the first year post-partum.

Each phone call will be similarly structured. After a warm greeting, the teen will be asked generally how things are going, how the pregnancy is progressing, whether they have any questions or issues that need addressing. If they do, referrals will be made.

Using the Working Alliance Inventory-Short Revised, or WAI-SR, scale, Bullock will then test the strength of the alliance developed between the teen participant and the person delivering the interventions, both the in-person and phone relationships, and look for variability.

In addition, all participating teens will receive a satisfaction survey by mail with a self-addressed stamped envelope a year after having their baby. They will be asked about their child’s health and development, measured for parental stress, polled about their family’s economic self-sufficiency, their achievements in and plans for education, and asked whether they have become pregnant again. The teens will also be screened for abuse and neglect. Those who don’t reply to the survey will receive a follow-up call.

“How we serve our most vulnerable populations has an enormous impact on their lives, and the lives of their children,” Bullock added. “Understanding the best, most impactful ways to serve pregnant teens – and understanding the methods they respond to best, and that are best for them – will inform the way millions in state and federal funding are divvied going forward.”

According to the Centers for Disease Control and Prevention, roughly one-third of girls get pregnant before age 20, which translates to roughly 750,000 teen pregnancies in America each year. Some $9 billion in federal programs are spent supporting pregnant teens and their families.

In Virginia in 2010, some 10,970 girls ages 15 to 19 became pregnant, a rate of 40.2 pregnancies per 1,000. Virginia’s southwest (56.9 per 1,000 teens) and eastern (59.2 per 1,000 teens) regions had higher-than-average teen pregnancy rates in 2010, while the northern (28.5) and the Shenandoah Valley (32.8) regions had the lowest.

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