Carol M. Lewis, Ph.D. Megan Scarborough Tandem Teen Prenatal & Parenting Program A Medically-Based Social Services Collaborative Carol M. Lewis, Ph.D. Megan Scarborough CENTER FOR SOCIAL WORK RESEARCH The University of Texas at Austin This research was supported by a grant from the Office of Adolescent Pregnancy Programs, Office of Population Affairs, U.S. Department of Health and Human Services.

Context - Central Texas Rapidly-growing 5-county region, pop 1.4 mil, mixed urban/suburban 1 in 4 Central Texans uninsured Rapidly growing Latino immigrant, Spanish-speaking population Teen pregnancy and subsequent pregnancy rates among highest in nation People’s Community Clinic located in Central Austin: a medical home to 11,000+ uninsured or underinsured Central Texans Tandem founded in 1998 by nurses & social workers at PCC the only clinic in Austin that offers specialized adolescent health care

Teen Births in Texas Tandem’s Approx. Service Area

Medically-Based Social Services Collaborative Combines Medical Home and Home/School Visitation Models Long-term, intensive case management, medical & mental health services Based at People’s Community Clinic in Austin, TX

Moving forward together Collaborative Partners Tandem Teen Prenatal & Parenting Program Moving forward together Tandem Partners include: PCC, indigent health care clinic 2. community-based organizations, LifeWorks and Any Baby Can And Austin Child Guidance Center

Target Population Ave. age (mean) 15.4 years 100% pregnant at intake 88% Hispanic, 8% Af. Am., 3% White 18% Spanish-speakers 84% in school

Program Goals for Clients Long-term relationship with Case Manager Positive health outcomes Improved Parenting Skills Client-driven goal setting Improved emotional wellness Strengthened family & social support networks Educational goals and self sufficiency Delayed subsequent pregnancies/Planned Families

Tandem Collaborative Components - Medical case management: prenatal, pediatric, reproductive, and adolescent health care and education - Weekly staffings between case managers, medical providers and mental health professional - Weekly mental health consults about each client, and direct service when appropriate - Long-term, Intensive Case Management

Intensive Case Management Case managers recruit patients during prenatal visits at clinic. Meet weekly during pregnancy, bi-monthly in the post-partum period, at least monthly thereafter, and more often when needed. Visits take place at home, school, clinic, and in the field. Case managers can provide transportation, and are easily accessible to help deal with medical, family and social crises as they arise. Case managers facilitate linkage to prenatal, parenting, and childbirth classes, fatherhood services, school-based groups, GED classes, vocational training, emergency shelter, legal assistance, etc. Small case loads (20-25 clients) = more intensive, individualized services compared to more traditional case management. Services last up to 3 years (ave. client stays in about 18 months)

Evaluation Design Quasi-experimental, repeated measures design with non- equivalent groups since teen parents are not randomly selected for a particular program or the comparison group (Cook & Campbell, 1979).

Evaluation Design (con’t) Case managers administer measures to intervention group Assessments take place every 6 months Quarterly outcome tracking Sample of interviews Scaled Measures for: Depression Anxiety Family & social support Relational health Parenting attitudes

Opportunities of Setting & Model Clients enroll during prenatal stage Evaluation recruitment via case manager Medical home & Case Manager engagement boosts retention & longevity Comparison group tracking via clinic contact information Monthly evaluation meetings with Tandem staff at clinic piggy-back weekly staffing Detailed knowledge about dosage and medical services provided to each client

Evaluation Challenges of Setting & Model Ethical concerns with randomization Slow start due to limited evaluation capacity, competing priorities in clinic Delayed baseline – medical priorities, rapport building & time constraints in clinic slow evaluation enrollment Potential bias associated with Case Managers collecting data Complexity of service (client-centered approach un-uniform) Evaluation a foreign concept for young, non-English speaking clients Clinic’s pro-adolescent environment contaminates Comp. Group

Lessons Learned Allow ample start-up time for Evaluation Capacity Building & ongoing training Meet monthly with all collaborative staff and again with collaborative directors Post bilingual recruitment flyers in clinic, inform clinic staff re: evaluation Access client contact case manager logs for details of individualized service

Lessons Learned Data collection staff onsite at clinic Gradually increase stipends to enhance retention Add HIPPA permission to evaluation consent for broader medical record access Anchor evaluation to child’s age/medical appts. Incorporate baseline data into program intake Employ CASI (computer assisted survey instruments) to collect data with case manager as proctor

Contact Information Carol M. Lewis, Ph.D. Associate Director, Center for Social Work Research School of Social Work, University of Texas at Austin carolmarie@mail.utexas.edu Tandem Teen Prenatal and Parenting Program www.pcclinic.org