Evaluation of Raising Adolescent Families Together Program: A Medical Home for Adolescent Mothers and Their Children

摘要

Objectives. This study described a medical home model for adolescent mothers and their children, and their 1- and 2-year preventive care, repeat pregnancy, and psychosocial outcomes. Methods. In this prospective, single cohort demonstration project, adolescent mothers (14–18 years old) and their children received care in a medical home. Demographic, medical and social processes, and outcomes data were collected at enrollment through 24 months. Change over time and predictors of repeat pregnancy were analyzed. Results. A total of 181 adolescents enrolled, with 79.6% participating for 2 years. At 2 years, 90.2% of children were completely immunized. Children and adolescent mothers met standards for health care visits, and adolescent condom use improved. Rates of cumulative repeat pregnancy were 14.7% and 24.6%, school attendance 77.6% and 68.7%, and employment 21.2% and 32.3% at 1 and 2 years, respectively. Conclusions. A medical home model with comprehensive and integrated medical care and social services can effectively address the complex needs of adolescent parents and their children. Adolescent mothers are at risk for depression and low self-esteem, and face significant health and socioeconomic risks. 1–5 Although most complete high school, they do so later than their peers, and have lower earnings. 6 Their children face significant long-term risks, with increased rates of adolescent pregnancy, school failure, and behavioral problems. 7 Young fathers often disengage with their children over time. 8,9 At least 20% of adolescent pregnancies in this country occur in adolescents who have already given birth to at least 1 child. 7 Delaying repeat pregnancy may enhance outcomes for both mothers and their children. 10–13 To address the complex and multidimensional needs of adolescent parents, intervention programs must provide a broad scope of services, targeting life and reproductive health skills, addressing social needs, and providing preventive care while teaching effective parenting behaviors. 10 Multidisciplinary programs have demonstrated improved child development and maternal long-term outcomes and modest reductions in repeat pregnancy. 12,14–17 Our previous work showed that adolescent parenting groups embedded within a medical and social services model enhanced self-esteem and decreased stress. 18 The medical home has been promoted as a transformative model for children with complex needs and is potentially an effective strategy for addressing the multiple medical, social, and educational needs of adolescent families. 19–21 The American Academy of Pediatrics (AAP) published a 1992 policy statement, which was modified in 2002, defining medical homes to include 8 desirable characteristics: accessible, family centered, continuous, comprehensive, coordinated, compassionate, developmentally appropriate, and culturally sensitive. 22,23 In 2001, the AAP recommended this approach for adolescent parents. 24,25 In 2007, the Joint Principles of the Patient-Centered Medical Home added emphasis on quality, safety, and value. 26 First described in the 1980s, teen-tot programs contained many of the elements of a medical home. They provided medical care and psychosocial support in an efficient, “one stop shopping” model. 27,28 However, few comprehensive evaluations of these programs have been published. 29,30 In this study, we describe a family-centered medical home model for adolescent mothers, fathers, and their children. We hypothesized that adolescent families receiving care within the teen-tot model would have improved medical and social outcomes compared with local and national benchmarks. We presented data on 3 major outcomes: (1) maternal and child health preventive care indicators, (2) repeat pregnancy rates and contraceptive adherence, and (3) adolescent life skills, including education, job attainment, and independent living.