Presented by Suzanne Knight, RN BSN Clinical Services Manager Stepping Stones A Home Visiting Program for Pregnant and Parenting Teens Presented by Suzanne Knight, RN BSN Clinical Services Manager Hello, and welcome to our presentation, Stepping Stones: A Home Visiting Program for Pregnant and Parenting Teens. I am Suzanne Knight, a Registered Nurse and the Clinical Services Program Manager with the Cabarrus Health Alliance in Kannapolis, NC. November 7, 2007

Cabarrus County Cabarrus Cabarrus Co. Population 158,000

Cabarrus Health Alliance “Public Health Authority” Separate from local government Community collaboration maximized Cabarrus Health Alliance is the public health authority of Cabarrus County, which is similar to a local health department. We provide traditional public health services, such as communicable disease and STD services, Environmental Health and clinical services, as well as wrap-around services – WIC, BL and Child Service Coordination, as well as many grant-funded special interest programs. We are located outside of Charlotte in central southern NC. MoreOur county population is approx. 150,000 Ethnic distribution is 41% AA, 32% caucasian and 32% Latina. The infant mortality rate for Cabarrus County for 2001-2005 was 7.4/1,000 live births, compared to the NC rate of 8.5/1,000. however, the disparity between minority and white 17.1/1,000 for AA compared to 5.6 for Caucasian. So although Cabarrus county’s incidence of teen pregnancy is comparable to the state’s the birthrate for Latinas teens is the second highest of all counties. The Cabarrus Partnership for Children is the local collaborative which encompasses our local Smart Start Agency. One of the main focuses of the Partnership is addressing prevention of abuse and neglect of children, with the overriding goal of Smart Start being school readiness and health. Because of the strong community involvement of the CHA with other community agencies, a partnership was developed to address the increasing number of young teenage women becoming pregnant and choosing to have and raise their babies. Smart Start, CHA, both school systems in the county, and the Department of Social Services worked together to identify some key issues within this growing population.

Community Characteristics Demographics population 158,000 increased 32.5% between 1990-2000 82% White, 12% African American, 6% other growth of number of uninsured and Medicaid outpacing growth in the overall population

Statistics Infant Mortality rate per 1,000 live births (2001-2005) African American: 17.1 White: 5.6 Abuse and Neglect increasing 45% of cases in 2005 were in ages 0 – 6 years

Problem Identification Recognition of need for early and consistent prenatal care Increased potential for abuse/neglect in teen parenting population Key issues: The potential for abuse and neglect, based on the data that adolescent and teen mothers are at higher risk for this, especially when taking into consideration their other socio-economic and psycho-social issues, such as lack of knowledge, isolation, and history of domestic violence. The lack of positive support for many of these teen moms, from parents and family, fathers of their babies, school, and friends and peers Physical and emotional struggles, including transportation to appointments, money housing child care, lack of parenting skills, substance abuse within their families, and other negative parental involvement Common cultural aspects that we identified included acceptance to bear and parent children at a young age, allowing the grandparents to have control of the baby and mother, and arranging marriages, although this was the least common situation. After looking at these issues, we wanted to take action and develop a program for this population, with the main focus on prevention of abuse and neglect.

Today’s Objectives Problem Approach Targeted Population Collaboration Evaluation How does this pertain to you? When you’re working in your community, and you see a problem or issue that slaps you in the face, you need to ask yourself, “What can we do about this?” Start with identifying the problem. For our clinic and community, the problem was uncontrolled gestational diabetes in an underserved population. For you, it may be asthma, or obesity in children, or teenage smoking. Move on to assessing your individual community assets, and every community has them. For example, we already had collaborative agreements with the hospital for some services, so it was a matter of talking to the right person to add some other items. We recognized that relationship as a major asset. Local churches and civic groups are often eager to help once they know of a need or project, either with time or financially. So think…. how can others help you to solve the problem? What other resources do you need? What other agencies are out there that have the same goals that you do that can help with funding? Our big-picture goal was to impact healthy birth outcomes and decrease infant mortality. We were able to identify the North Carolina Chapter of the March of Dimes as a funder with similar goals. Don’t forget to evaluate, as that’s the way to help sustain your program in the future. This will also help you determine whether you have accurately defined the problem, and whether needs are truly being met. At Cabarrus Health Alliance, we really feel like we are making an impact on the problem of gestational diabetes in underserved clients in our community, and I hope this has helped you to realize that you can make an impact, too.

Target Population First Time Pregnant/Parenting Teens Lack support Lack parenting skills Negative role models “Breaking the cycle”

Target Population Barriers Transportation Money Housing Child Care

“Stepping Stones” Home Visiting Program Goals encourage behaviors that prevent abuse and neglect establish medical homes identification and support of personal goals Here is what we did to start to address the issue of adolescent and teenage pregnant and parenting women, with limited support and resources: Using recommendations from funders, as well as other community partners, including Department of Social Services, we set goals for the program, including target population. DSS not only served as a referral source, but quickly became an ally as child care for our teens to return to school became an issue. We assessed the population to determine and prioritize their needs. We researched curriculums with regard to the learning levels and needs of our population and developed a program utilizing the research-based Florida State University Center for Prevention and Early Intervention Policy: Partners for a Healthy Baby. Data is collected on an on-going basis, which has not only assisted with sustainability, but also served as a basis for growing the program, which I will touch on later.

Collaborative Partners North Carolina’s nationally recognized early childhood initiative The Cabarrus County Partnership for Children

Collaborative Partners Cabarrus County Department of Social Services School System Social Workers CHA School Nurse Program

Service Delivery Intensive Home Visits Registered Nurses

Home Visiting Schedule Individualized, ideally beginning first trimester Weekly for 1-2 hours first six weeks Bi-weekly until birth Weekly for two months As mentioned before, the primary goal of the Stepping Stones Program is the prevention of abuse and neglect in this high risk population. The attainment of this goal goes hand-in-hand with the next goal of providing support , education and referrals. The intensity of visits made by the nurse to the client is tailored to met the needs of the individual, and also determined by gestation of pregnancy and age of child. However, 14

Home Visiting Curriculum “Florida State University Center for Prevention and Early Intervention Policy: Partners for a Healthy Baby”

Curriculum Educational Topics Early and consistent prenatal care Childbirth Child Development Well child checks/Immunizations Anticipatory Guidance Family Planning Counseling

Curriculum Modeling Parent/Child Interactions Feeding Bathing Playing Reading Safe Sleep Oral Health Care

Program Update 3 full time RN’s 1 full time LCSW 0.5 FTE Processing Assistant Current caseload of 75

Program Evaluation Quarterly reports 100% enrolled in medical home 100% up to date on immunizations 70% meeting their educational goals 1 substantiated case of neglect in 5 years

For More Information Suzanne Knight, RN BSN Cabarrus Health Alliance 1307 South Cannon Boulevard Kannapolis, North Carolina 28083 704-920-1322 (office) 704-933-3345 (fax) Website: www.cabarrushealth.org Thank you for your time!