1. 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.

2. 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

3. Teen Births in Texas
Tandem’s
Approx. Service
Area

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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)

10. 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).

11. 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

12. 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

13. 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

14. 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

15. 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

16. Contact Information
Carol M. Lewis, Ph.D. Associate Director, Center for Social Work Research
School of Social Work, University of Texas at Austin
Tandem Teen Prenatal and Parenting Program