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Barnet, B., Rapp, T., DeVoe, M., & Mullins, C. D. (2010). Cost-effectiveness of a motivational intervention to reduce rapid repeated childbearing in high-risk adolescent mothers: A rebirth of economic and policy considerations. Archives of Pediatrics and Adolescent Medicine, 164(4), 370-376.

Model(s) Reviewed: CAMI+ , Computer-Assisted Motivational Intervention (CAMI)
Additional sources:


Barnet, B., Liu, J., DeVoe, M., Duggan, A. K., Gold, M. A., & Pecukonis, E. (2009). Motivational intervention to reduce rapid subsequent births to adolescent mothers: A community-based randomized trial. Annals of Family Medicine, 7(5), 436-445. doi:10.1370/afm.1014

Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
Rating Design Attrition Baseline equivalence Reassignment Confounding factors
High Randomized controlled trial Low Not applicable None None
Study characteristics
Study participants Pregnant teenagers were recruited from urban medical clinics that provided prenatal care to women without insurance or who were insured by Medicaid. The teens were assigned randomly to one of two intervention groups (CAMI and CAMI+) or a control group. Initially 235 pregnant teenagers were randomly assigned, 167 to the treatment groups (87 to CAMI and 80 to CAMI+) and 68 to the comparison group. Most were poor, African American, and unmarried. Mothers ranged in age from 12 to 18 years old at intake (24 weeks or more gestation). Ninety-seven percent of the mothers were African American. Participants were followed for 27 months.
Setting The study was conducted in Baltimore, Maryland.
Intervention services The intervention included two home-based treatment groups: CAMI and CAMI+. The CAMI intervention began after the delivery of the participant’s child and sessions were held every three months until the child turned 2 years old. A participant assigned to the CAMI group met with her counselor to assess her current behaviors and to receive “motivational interview counseling” that encouraged the participant to use contraception and avoid future rapid subsequent pregnancies. The participant and counselor worked together to establish short- and long-term goals. Adolescents assigned to the CAMI+ intervention received all the services given to those in the CAMI group plus more intensive services. These services included additional monthly home visits with a CAMI counselor, which involved case management and education on effective parenting. Participants received a maximum of nine home visits by a CAMI counselor.
Comparison conditions Comparison group members received usual care at their prenatal care sites.
Staff characteristics and training Trained community outreach workers (CAMI counselors) were African American paraprofessional women who were members of the communities where participants resided. The counselors were hired for their empathetic qualities and rapport with adolescents. Before the intervention, CAMI counselors received special training on motivational interviewing and the CAMI protocol. In the project’s first four months, the counselors met biweekly to further hone their motivational interviewing skills (Barnet et al. 2009).
Funding sources Department of Health and Human Services, Office of Population Affairs, Office of Adolescent Pregnancy Programs, Grant APRPA006010.
Author affiliation Beth Barnet, a study author, is a developer of this model.

Findings details

Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Repeat birth
FavorableUnfavorable or ambiguousNo Effect
CAMI vs. control 24 months postpartum 148 mothers % = 17.00 % = 25.00 = -0.08 HomeVEE calculated = -0.29 Not statistically significant, p=0.08
High Repeat birth
FavorableUnfavorable or ambiguousNo Effect
CAMI+ vs. control 24 months postpartum 148 mothers % = 14.00 % = 25.00 = -0.11 HomeVEE calculated = -0.44 Statistically significant, p=0.01

Outcome measure summary

Maternal health
Outcome measure Description of measure Data collection method Properties of measure

Repeat birth

Percentage of repeat births occurring within 24 months of the index birth

Review of birth records

Not applicable