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Implementing Early Intervention Program for Adolescent Mothers

Meets DHHS criteria for an evidenced based model

Implementation Experiences

Last Updated

July 2011

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Summary of Sources

Information in this section is based on four studies included in the Home Visiting Evidence of Effectiveness (HomVEE) review. For the EIP, we reviewed one randomized controlled trial (RCT) study rated high and three RCT studies rated moderate. (Please see the study database for a list of the studies.)

All four studies reviewed were based on the same initial sample of participants. Because of this overlap, we refer to these as one study sample throughout this section.

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Characteristics of Program Model Participants

The study sample included 63 participants enrolled in the EIP at intake.

All participants in the study were female and 17 years old, on average, at intake. Participants enrolled in EIP when they were, on average, 21 weeks pregnant. Family members, such as the father or the maternal grandmother, were invited to participate in all activities.

About two-thirds of mothers initially enrolled in EIP were Hispanic, 19 percent were white, 10 percent were African American, and 6 percent were another race/ethnicity.

At intake, mothers were from a low socioeconomic background, 17 percent were employed, and almost all were single (97 percent) and in their first pregnancy (78 percent). Two-thirds were enrolled in high school, slightly more than one-fifth had dropped out, and 8 percent had graduated or earned their General Education Degree (GED).

Participation in EIP was voluntary.

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Location and Setting

The study was implemented in southern California’s San Bernardino County, which has urban and rural communities, an ethnically diverse population, and a high teen birth rate relative to state and national rates.

EIP was implemented as a collaborative demonstration project by the University of California at Los Angeles School of Nursing and the San Bernardino County Department of Public Health, Division of Community Health Services.

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Staffing and Supervision

EIP was delivered by six public health nurses who were employees of the county health department and contracted by the university for the EIP demonstration. The study also employed a public health nurse supervisor from the health department and four public health nurse recruiters who invited eligible adolescents to participate.

The public health nurse home visitors had, on average, five years of experience with the county health department, a bachelor’s degree in nursing, and a public health nursing certificate from the state of California.

Pre-service training for public health nurses was approximately 60 hours, followed by periodic in-service sessions. The public health nurse supervisor and the project director oversaw the nurses’ implementation of study protocols.

The study reviewed did not include information about staff caseloads.

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Program Model Components

The EIP public health nurses offered home visits to families from mid-pregnancy through one year postpartum. The public health nurses delivered services using a case management approach, with one nurse providing continuous care to her assigned caseload. All activities were designed to build the social competence of mothers to help them more effectively manage their lives and provide appropriate infant and child care. The program included a maximum of 17 home visits—2 prenatal and 15 postpartum—each lasting 1.5 to 2.0 hours. Postnatal visits were to occur during weeks one, four, and six, and at monthly intervals between 2 and 12 months postpartum. In addition, public health nurses conducted four classes focused on the transition to motherhood, fetal development, parent-child communication, and maternal health.

During home visits, the public health nurses covered five main content areas: health, sexuality and family planning, maternal role, life skills, and social support. Prenatal visits focused on adequate use of heath care, preparation for childbirth, and self-care during pregnancy. During postpartum visits, mothers received information on family planning, infant care, and well-baby health care. Interventions were designed to help mothers develop communication skills and learn how to assess their infants’ needs, respond to distress, and interact reciprocally with their infants. The public health nurses also counseled adolescents on maternal role issues, education attainment, substance use, and mental health issues such as handling emotions. They also initiated referrals as needed for mental health counseling, family planning, and child care.

The public health nurses implemented all aspects of nursing care using standardized protocols. The EIP protocols were organized around the nursing process and covered each of the five content areas (health, sexuality and family planning, maternal role, life skills, and social support).

The study reviewed did not report whether home visitors or materials were available for non-English speaking families.

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Program Model Adaptations or Enhancements

The study reviewed did not include information on adaptations or enhancements.

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Dosage

Three of the articles described the actual level of services delivered. The actual number of home visits participants received varied depending on the mother’s availability; dependability in keeping scheduled appointments; and the public health nurse’s ability to locate mothers, for example, after household moves. In most cases, participants received 2 prenatal visits, 2 or 3 visits within the first six weeks postpartum, and 10 monthly visits until the infant’s first birthday.

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Fidelity Measurement

One article described the process for measuring program fidelity. Fidelity was documented using prenatal and postpartum forms in which nurses recorded the program components they provided. In addition, the supervisor and the project research director oversaw the nurses’ implementation of study protocols.

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Costs

The study reviewed did not include information on program costs.

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Lessons Learned

One of the articles reported a lesson learned about implementing the model components. Reviews of the forms capturing program delivery and the nurses’ health care records revealed that videotherapy was the greatest implementation challenge. A variety of factors contributed to this challenge, such as infants sleeping during the home visit and mothers refusing to be videotaped.

Another article reported that time and role conflicts occasionally arose for public health nurses, who carried a caseload of EIP participants plus health department clients.

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