Program Goals/Target Population
The goals of the Home-Visiting Program were to improve parenting beliefs and childrearing practices, promote school continuation, reduce repeat teen pregnancies and maternal depression, and improve connection to primary physicians among adolescent mothers through a home visitation, mentoring, and case management intervention.
The program was targeted toward adolescent mothers or mothers-to-be, particularly those living in urban, low- income communities. Eligible participants were between 12 and 18 years of age who were either in their third trimester of pregnancy (at least 24 weeks gestation) or had delivered a baby in the previous 6 months.
Program Components
Eligible participants were recruited into the program and were involved until their children were 2 years old. Each program participant was paired with one volunteer home visitor. The home visitor made biweekly home visits to the adolescent mother for the first year of the child’s life, followed by monthly visits until the child was 2 years of age. Most visits occurred in the home of the adolescent mother, but these meetings could also take place elsewhere in the community if there were concerns about safety. During these in-person meetings, the home visitor provided mentoring to the participating youth, delivered the adolescent and parenting curricula, and monitored for depression, partner violence, and school status. With the mother’s consent, the child’s father was also invited to participate in the parenting sessions.
The parenting curriculum sessions were aimed at 1) improving adolescent mothers’ understanding of child development, 2) teaching/modeling positive parenting attitudes and skills, and 3) promoting appropriate health care use by making connections with primary health care providers. The adolescent curriculum was aimed at 1) increasing the likelihood of engaging in safer sexual practices, 2) preventing repeat teen pregnancy, 3) setting goals oriented toward school completion, and 4) fostering skills to improve communication and negotiation with the adolescents’ partners.
Multidisciplinary staff meetings were held biweekly. During these meetings, home visitors could discuss concerns about participants’ mental health. If needed, referrals were made to the program social worker for further evaluation and counseling. Home visitors also worked with school personnel and parents to actively promote school continuation or re-engagement. Additionally, home visitors connected adolescents with primary care for management of contraceptive needs, helping them select a primary care site based on insurance requirements, location, and preference.
Key Personnel
Female home visitors were recruited from the communities served by the program. They received 2 days (16 hours) of initial training in the use of the curriculum as well as ongoing training throughout the intervention period in the topic areas of depression, contraception, substance use, and domestic violence. Additionally, home visitors completed criminal background checks and an extensive screening process that assessed their motivation. Each home visitor had a caseload of up to 15 adolescents whom they visited biweekly, and up to 10 adolescents whom they visited monthly.
Home visitors needed to have at least a high school degree and experience in health care, child development, or social work. Home visitors also needed to possess skills for empathy and communication, have the ability to connect with adolescents and their families, and have knowledge of the community. The program team also included a social worker, who consulted with home visitors regarding mental health concerns and then followed up with evaluation and further referral to mental health or primary care services if required.
Program Theory
The program was grounded in Bronfenbrenner’s (1979) ecological model of human development, which emphasizes the role of social and environmental contexts as contributors to youth development as well as the value of locating interventions within the immediate environment of adolescents. The two curricula were grounded in social cognitive theory (Bandura 1986), which emphasizes social influences on learning and reciprocal influences between an individual, the person’s environment, and the person’s behavior. Furthermore, the curriculum was developed by both a child developmental psychologist and an anthropologist with the aim of making it specifically relevant for the target population of urban, African American adolescent mothers.
